HomeMy WebLinkAbout516 Stover St - Applications/Reroof - 06/12/2012 (3)of
F6it Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box Sao
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This ajjpiication is to be used to apply for the following permits only (check ail that apply). 0 Air Conditioning
0 Demolition (interior non-structural) ❑ Electrical Alteration (not service change) 0 Gas Lighter ❑ Gas Log
Ll Heating Unit' 0 Lawn Sprinkler 0 Mobile Home replacement ❑ Roofing 0 Sewer Line I] Photo -voltaic
C1 Ventilation Cj Water Heater ❑ Water Line ❑ Wood/Pallet Stove (must be EPA certified, provide make, model and
manufacturer). '
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application - Date
For ofte use only
Job Site Address (required) Value of Constructipn (labo material , profit)
514 Stt�/er sf, $ wlett- z 9So° 7/6 2
r- —
Property Owner Name Address
City/State
Zip Phone
,51V,4>U S_f4 Goro( S/6 51allPr sf /'7,(611,A1 ex
BdS1 y
IYZ U - 5?77
Applicant Name Address
_
City/State
Zip
Phone
P.y. $oX !160
_ Ir B'
86T33__
FContractor Lic # Address
City/State
ZIP
Phone
� oSlr9qu ,&ciCiA} -/227 0
f Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here
or by report?Here 0 Report
Sales tax num4er is required by ali cvnbacfors
Are you paying with your trust account:7
❑ Yes ❑ No
/Q 17
_
t _
Is this a residential or c mercial project? Residential 0 Commercial
E If residential, is it: Sringle Family Detached 0 Condo/townhome (single family attached) 17 Duplex
I 0 Multifamily (apartment) 0 Garage
If commercial, is It: 0 Bank CU Bar ❑ Church i[3 Hotel/Motel ❑ Medical office n Office ❑ Retail
O Restaurant D\Oth r (explain)
Is this building 5o years of age or more' ;8�1'es 0 No If yes, you may need to contact Historic A-eservation
If this is for a demolition permit, what year was the building constructed?
if prior to 1975, you will need an asbestos assessm%,nt to submit wadi this applicvtron.
Description of work
Jr,
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
SubconIzactors: List the company name or G'ty of Ft Collins license 4
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
corr,iAy 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
Applicant., �ioTi�ta a _gate
Print Name, ti r! ;'� Signature �L—��� —