HomeMy WebLinkAbout2632 Canby Way - Applications/Reroof - 04/26/2012Artisan Roof Repairs LLC
970-223-9501
p.3
,City ofr
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
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) CI Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
complete all applicable information on the application. Incomplete applications will not be accepted_
Application #.
For ofike use only
Date
Sob Site Address (required)
Value of Construction (labor, materials, profit)
Property Owner Name
Address City/State Zip cry Phone 9-00
Applicant Name AviZ7�7Ct
Address Gty/state Zip Phone 970
Contractor _
Address T City/State Zip Phone c/70
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?'Here ❑ Report
sales tax nwnneresrequkedbyaamnnacrors:
Are you paying with your trust account? ❑ Yes [Vto
Is this a residential or commercial project? N;Zktesidential ❑ Commercial
If residential, is it: 15 Single Family Detached ❑ Condo/bownhome (single family attached) ❑ Duplex
/0 Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes No If yes, you may need to contact HistaicprL-servatlon
If this is for a demolition permit, what year was the building constructed?
Ifprror to 1975, you wfD raced an asbestos assessment to submit with this application.
Of
*If lawn sprinklerAacl iow preventer, must list licensed plumber. If 'first-time A/C, must list licensed electrician.
Subcontractors: List the companyname or City oFR Collinslicense #
Electrician Plumber Mechanical Roofer Other
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 C 7.1 ) f ^�
Print Name %� l\ J Siyrature!% Date Z& r cf
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