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HomeMy WebLinkAbout2720 Autumn Harvest Way - Applications/Reroof - 08/11/2014Li 14.16� Planning, Development & Transportation City Of 281 N. College Ave P.O. Box 580 Fort Collins Fort Collins, CO 80524 /� Phone 970-416-2740 Fax 224-6134 I OVER-THE-COUNTER PERMITS ONLY j 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 j ❑ 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 # 1� � �y5, J 2 Date J� - It - ZD ) For office use only I Job Site Address (required) Value of Construction (labor, materials, profit) 0—)Q v f\u, T 'r" 0 fLV t35,j W R- .� Property Owner Name Address City/State Zip Phone CrArT I, --A. a csrl_ Sn �-. i t 1= f , L' © L L i , & 905 a �? 9;& Applicant Name Address City/State Zip Phone j Contractor Address Srato.l City/State Zip Phone CB0oc,� l2oor %I 1957 1v)mo,us St' �-lAtco-wmol� co SCQ)Ll to, -3_?Q5 Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? XHere ❑ Report sales tax number is required by all contractors: Are you paying with your trust account? ❑ Yes ❑ No j 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 ❑ Office ❑ Retail ❑ Restaurant ❑ Other (explain) Is this building 50 years of age or more? ❑ Yes _-Zi!�N_o If yes, you mayneed 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 workA_4,gt4 Z r..l bf,,P 2Aiza— i=crr_i Q *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 # 'gelwcoD 4401-t'' 9 Electrician Plumber Mechanical Roofer Other i t 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 tha permit Is not valid until It has been paid and Issued. Applicant: �5� V i i!P�/ "7^ 1- 20/ Print Name: G Nl�e J Signature Date 8 - /