HomeMy WebLinkAbout132 Yale Ave - Applications/Reroof - 07/03/2014Planning, Development &Transportation
City of 281 N. College Ave P.O. Box 580
Fort CoWnS 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) ❑ 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 # b 1< b""Az� . Date 0 -7 1D .1
For office use only
Job Site Address (requirepp)
Value of Construction (labor, materials, profit)
Property Name I
Address
City/State Zip
Phone
/Owner
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9 0U
I of
Applicant Name
Address
City/State Zip
Phone
Contractor
Address
City/State Zip
Phone
Q
Contractor City of Ft. Colli S Tax #
sales tax number is required by all contractors "7-7
Are you paying with your trust account?^es
❑ No
Is this a residential or commercial project? -Residential ❑ Commercial
If residential, is it: single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office 11 Office ❑ Retail
❑ Restaurant ❑ other (explain)
Is this building 50 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
4
S�r- i —' ✓Yt OU' ✓ a t r v
*If lawn sprinkler/backflow p enter, must list licensed plumber. If first-time A/c, must list licensed electrician. 7r'&, OM
Subcontractors: List the company name or City of Ft Collins license # 'pa;f I or-C
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. //5�'
Applicant: /, n �p 1%''� ')
Print Name• � v tJ7 "� Signatur Date