HomeMy WebLinkAbout1427 Redberry Ct - Applications/Reroof - 06/07/2012 (2)FortCollins
Planning, Development & Transportation
281 N. College Ave P.Q. 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
O Demolition (interior non-structural) ❑ Electrical Alteration (not servi change) ❑ Gas Lighter ❑ Gas Log
0 Heating Unit ❑Lawn Sprinkler ❑Mobile Home replacement Oofing ❑Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Strive (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable Information
�on the application. Incomplete applications will notbeaccepted.
ADDlication # � �l�lJ �" I ;) I 1120-e ( () --1 " � /
For of a use only
tx
]ob site Address (required)
Vat of construction (labor, materials, profit)
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Pro� Owner Name
Address
G /State Zip Phone
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Applicant Name
ddress
U City/State _ Zip Phone
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Contractor
ress
aty/State 7-1p one
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93
3
v 943+(0 30
Contractor City of Ft. CollKs Salk Tax #
Are you paying taxes here or by report? ❑ Here ❑ Report
Shcestax number��equl byallrn &acrom
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Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or Commercial project? residential ❑ Commercial
If residential, i5 it: Ingle Family Detac ed ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: O Bank ❑ Bar ❑ Church ❑ Hotel/Motel O Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other(ex (explain)
Is this building 50 years of age or more? ❑ Yes If yes, you may need to contact Hrslaric Preservation
If this is for a demolition permit, what year wa the building constructed?
If prior to i975, you wll/need an asbestos assessment to submit with This app/icat/on.
of work
*If lawn sprinkler/backflow preventer, must list f r. If first-time A/C, must list IlcenSed el ciao.
Subcnrx ors: List the c name or Gty offt Collins //tense ;
Electri�cian� Plumber Mediankai 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 constriction. I know that a
permit is not valid until it has been paid and issued.
Applicant v' mALne�'
Print Flame: Signature
Date
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