HomeMy WebLinkAbout1174 Picard Ln - Applications/Reroof - 08/14/2014o{ Planning, Development & Transportation
Cat
Flirt C®®t i n c Fort N. College Ave P.O. Box 580
l .7 Collins, CO 80524
Phone 970-41616-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
-This-application is to be used -to -apply -for the -following permits; only_(.check all that -apply). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service cliarhge) Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement It Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
___,=._maaufaeturer:)..---- - - - - -
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # R1 11_1 0693g 3 Date im
For office use only
Sob Site Address (required)
Value of C
nstruction (labor, materials, profit)
Property Owner Name Address
City/State
Zip
Phone
T lnie //7R1c rr1 1a
Co
80574,
53& 4'IZS
Applicant Name Address
City/State
Zip
Phone
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Ltoao C. I--rc_
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Contractor Irc # Address
City/State
Zip
Phone
Fb 4 Davt s n-�,76 36Llvt.co c T-c c>a
Soslq
Zzj-1z8r
Contractor City of Ft. Collins Sales. Tax #
Are you paying taxes here or by report?
110 Here ❑ Report
sales tax number is required by all contractors.
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Are you paying with your trust account?
0 Yes ❑ No
Is this a residential or commercial project? QKesidential ❑ Commercial
If residential, is it: fkfingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑. Restaurant ❑ Other (explain)
Is this building SO years of age or more? ❑ Yes ❑ No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license #
Plumber
Mechanical Roofer Iu tY ther
� sn'eY
I hereby acknowledge that I have read this application and state that the above information is complete and correct. I agree to
comply with all requirements contained herein and city ordinances and state laws regulating building construction. I know that a
permit is not valid until: it has been. paid and issued.
Applicant: \
Print Name: E44C �"wSignature n Date e7 Iy IL