HomeMy WebLinkAbout2419 Kenosha Ct - Applications/Reroof - 05/03/2012City. CYf Planning, Development & Transportation
N. College Ave
�1 ` Collins 281 Fort Collins, CO 80524 P.O. Box 580
Phone 970-416-2740 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 change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement/IV'Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Peliet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # 512-DZ- [ Date
For aft a ase a* I A4
lob Site Address (raquftd)
Val a of Construction (labor, materials, profit)
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Property Owner Name Address
City/State Tip Phone
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Appiicant Name Address
City/State Zip Phone
Contractor Address
City/State Zip Phone
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Contractor City of R. Collins Sales Tax #
Are you paying taxes here or by report? AI' Here ❑ Report
sales ter number & required by alb condors
Are You paying with your trust account? ❑ Yes ANo
Is this a residential or commercial project? JXResidentiai ❑ Commerdal
1f residential, is tt: ,jlr�Single Family Deti5d e 0 Condojtownhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
if commercial, is it: ❑ Hank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
is this building So years of age or more? ❑ Yes ErNo If yes, you may need to contact HLstonic Preservation
If this is for a demolition permit, what year was the building constructed?
If fora, to 1975, you will need an asbestos assesrnent to wbm/t wi6h this application.
Description
*If lawn sprinkler/baddlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
SubeonOaetors List fire company name or City of Collins license 0
Wumber Mechanical Roofer Other
I hereby acknowledge that I have read this appiiration and state that the above infomwtion Is complete and correct I agree to
campy 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 Plante: / * OW —r" gL4c-- signature
Date ��;!�9L