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HomeMy WebLinkAbout5309 Country Squire Way - Applications/Reroof - 08/11/2014To: Page 5 of 7 2014-08-11 16:49:17 (GMT) k 18663247566 From: Julian Rector 1 Planning, Development & rransportabon Cit Of 281 N College Ave PC) Bo 580 Fart Collins fort Collins, CO 80524 Phone 970-416.2740 Fax Z 4-6134 OVER-THE-COUNTER PERMITS ONLY This application is to be used to apply for the following permits only (check all that appl ). O Air Conditioning * Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Ligt ter 0 Gas Log ❑ Heating Unit ❑ Lawn Sprinkler 0 Mobile Home replacement . 'Roofing ❑ Sewer Line 0 photo -voltaic ❑ Ventilation 0Water Heater ❑ Water Line ❑ Wood/Pellet Stave {must be EPA certified, ovide make, model and Sob Site Addrm (requred) value of Conp#%licido ('la materials, profit) P.sro.iyvltil a^ D. �/Ifrza,YflW1C G App cdnt Name Address ty/totoPhone - �� .-i. , i;t1 L•' `-'? . ' .. ..: C011trddr CAddress CitY/State . zpl phone `L r re ❑ Here deport Gontractor.City of Ft, CaHins,$ales Tax Are you -paying taxes here or by report? sores m r numaerrsre+g oW by an cantracrors. Are you paying with your trust acco t? Q Yes C to Is this a residential or commercat project? dResidential C1 Commercial if residential, is it: 1!�-tngle Family Detached 0 Condo/townhome (single family attached) ❑ Duplex ❑ Multifamily (apartment) ❑ Garage If commercial, is it: ❑ Bank © Bar Church 0 Hotel/Motel 13 Medical office 0 Office 13 RfaN ❑ Restaurant t7 Other (explain) Is this building 50 years of age or more? i3Yes El -No Dyes, you may need to contact H/st ncPYeservation If this is for a demolition permit, what year was the building constructed? If pnor to 1975 you will need an asbestos assessment to submit with #his application. Description of work ' * L-Cni -'P- Lenad 9-. `7 1` *if dawn spri er/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician. Subcontractors: List the company name or City of Pr Collins license ,# 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 regulatng building ccnstruction. I know that a permit is not valid until it has been psid wW issued. Applicant: Print Name: �,1 �� ,. _ ��' �iignature _ r