HomeMy WebLinkAbout4536 Bluefin Ct - Applications/Reroof - 08/08/2014I Of Planning, Developmi
F6I ` CollinsFort N. College Ave P
1 , Collins, CO 80524
�'1 /. -.000MMM..' Phone 970-416-2740
OVER-THE-COUNTER PERMITS
This application is to be used to apply for the following permits only (check all tha
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ GE
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certi
manufacturer).
Complet app icable i f rm tion on th application. Incomplete applications w
4 A PPlicatie # - Date CJ
For office use only
& Transportation
Box 580
224-6134
LY
apply). ❑ Air Conditioning
; Lighter ❑ Gas Log
_ine ❑ Photo -voltaic
ad, provide make, model and
11 not be accepted.
7
Job Site Address (required)
45 3fv �(
,. % -
Value of Construction (labor, materials, profit)
190 C)
//Property Owner NN e
Address
(� City/State
Zip
Phone
C7tPor /`— S
c5w
Applicant Name
Address
City/State
Zip
Phone
.3kh
psi
5. cit I
Contractor
Address
City/State
i Zip
Phone
Contractor City of Ft. Colli s S Tax #
Sales tax number is required by all contractors. #0077
Are you paying with your trust
account? Yes ❑ No
I
Is this a residential or commercial project? >6 Residential ❑ Commercial
If residential, is it: }Single Family Detached ❑ Condo/townhome (single family attach ed) ❑ 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 fpNo 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 applicatlon. i \
Description of work
*If lawn sprinlder/backnow preventer, must list licensed plumber. If first-time A/C, must list
Subcontractors: List the company name or City of Ft Collins license #
Electrician Plumber Mechanical Roofer
I hereby acknowledge that I have read this application and state that the above information is
comply with all requirements contained herein and city ordinances and state laws regulating bi
permit is not valid until it has been paid and issued.
Applicant: L
Print Name: O "~ W
electrician.
Other
SA'-5
ete and correct. I agree to
construction. I know that a
9r 8 _/5/
15