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HomeMy WebLinkAbout1207 Mariposa Ct - Applications/Reroof - 07/30/2014To: Page 3 of 4 2014-07-30 18:49:28 (GMT) 18663247566 From: Julian Rector Planning, Development & Transportation rCltyOf 281 N. College Ave P.O. Box 580 F(5rt ,\ ,,,,d��n,s Fort Collins, CO 80524 ~�_ Phone 970-416-2740 Fax 224-6134 OVER-TH' COUNTER PERMITS ONLY This application is to be used to apply for the following permits only (check all that apply). O Air Conditioning Q Demolition (interior non-structural) G Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log 0 Healing Unit O Lawn Sprinkler ❑ Mobile Home replacement O Roofing 0 Sewer Line ❑ Photo -voltaic O Ventilation 0 Water Heater ❑ Water Line L 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. Applicatior # Date For office use only Sob S/i�tye�7o lddress (requW) Value of Construction (tatior, materials; profit) A f Property Owner Name Address City/State Zip Phone % ti'li ',;!'l 1 ; fiC_ ; ;Pu, , 'G % i4 a%E tii� -�Vs2 Applicant Name Address City/State Zip Phone 1; Contractor _ Address City/State Zip Phone .- 5 Contractor City of Ft. Co$pS Sales Tax # Are you paying taxes here or by report? ❑ Here 6;"Report Sales tax number it b .a/Lcrm tu's Are you paying with your trust account? 0 Yes Q4`to �is �t4���� , Is this a residential or,,c99mmercial project? .,Residential O Conu tercel If residential, is it: 6-9mgle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex Multifamily (apartment) D Garage If commercial, is it: 17 Bank R Bar © Church 0 Hotel/Motel C] Medical office O Office O Retail ❑ Restaurant CI Other (exi m) Is this building 50 years of age or more? O Yes P• No If yes, you may need to contact Historic Preservation If this is for a demolition permit, what year was tfie building constructed? If pr1or to 1975, you will need an asbestos assessment to submit with this application. Description of wprk *If lawn sprinkler/backfiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician. Subcontractors: List the company name or City of Ft Collins license 4 Electrician Plumber Mechanical Roofer .& 7 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. AppliPrint Name: the. _ / Signature