HomeMy WebLinkAbout713 Meadow Run Run Dr - Applications/Reroof - 08/08/2014Planning, Developm,
City}Of 281 N. College Ave P
Fort Collins Fort Collins, CO 80524
Phone 970-416-2740
OVER-THE-COUNTER PERMITS
This application is to be used to apply for the following permits only (check all the
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ G
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewe
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA cerl
manufacturer).
Complete all applicable information on the application. Incomplete applications i
Application # f 1 ev: Date
L're' t—'*orA'ice:u'e o`nly U U
& Transportation
Box 580
224-6134
N LY
apply). ❑ Air Conditioning
> Lighter ❑ Gas Log
-ine ❑ Photo -voltaic
ed, provide make, model and
I not be accepted.
Job Site Address (required)
®
Value of Construction (labor, materials, profit)
Pro erty wn Name
Address
City/State Zip
Phone
f V, 4
71 3 /'' ep A-0
i
Applicant Name
Address
City/State Zip
Phone
c
I
�7o-bgo -�8
Contractor
Address
City/State j Zip
Phone
Contractor City of Ft. Colli s Sa es Tax # i
Sales tax number is required by all contractors.�OS77 Are you paying with your trust!account?
i
21yes ❑No
Is this a residential or commercial project? >6 Residential ❑ Commercial
If residential, is it: .2Qingle Family Detached ❑ Condo/townhome (single family ati
❑ Multifamily (apartment) ❑ Garage
If commercial, Is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑
❑ Restaurant ❑ other (explain)
Is this building 50 years of age or more? ❑ Yes pOo If yes, you may need to cor
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 application.
Description of work
*If lawn sprinMer/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
!d) ❑ Duplex
-e ❑ Retail
Historic Preservation
e
r G i►+in 4
;ed electrician.
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.
Applicant: 'n/t
Print Name: 0
5