HomeMy WebLinkAbout1238 Belleview Dr - Applications/Reroof - 07/21/2014Fort Collins
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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) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement 3K Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation 0 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 # �2140 lI�4T
2q Date �J �c-it1 �I/ a014
For o ce use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
1a3g BeAleview -br
Property Owner NWe Address
City/State Zip Phone
J-�d so n 4 6a4S Sarre
FI- eo flids CD 80S 6 q7o-Sfrl -87
Applicant Name Address
City/State Zip Phone
MaAGL 20 CuAflacm
0
Contractor Address
City/State - Zip Phone
SiAoradegt;
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? CWHere ❑ Report
Sales texnumberisrequired byall cnbacn%—
53
Are you paying with your trust account? ,Qp Yes ❑ No
VOfl-f CoLtAIIIS 1AC46tISS -
Is this a residential or commercial project? X Residential ❑ Commercial
If residential, is it: 53 Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex l b c
❑ Multifamily (apartment) ❑ p(
Garage ^ stY tW
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? O Yes of No If yes, you may need to contact HcstoricPreservabbn
If this is for a demolition pennit, what year was the building constructed?
Ifpr/or to 1975, you will need an asbestos assessment to submit w/th this applIcatron.
work
*If lawn sprMkier/bacldiow preventetVmust list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or 0y of Ft Collins license 2 27 9
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.
Print Name: VI Val1Yl . S(QAAA fn Signature Date