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HomeMy WebLinkAbout155 Palmer Dr - Applications/Reroof - 08/14/2014of Fort Collins OVER - Planning, Devebpmo* a Tic Apwftegotl 281 N. College Ave P.O. ewc NO Fort.Cailim, CD 8=4 Pltorne 13M 416-2740 FaDc 224-62M PERMITS ONLY This application is to be used to apply for the fallowing permits only (check all that apply). ❑ Air Conditioning O Demolition (interior non-structunal) C3 Electrical yNtsration (not sen&e change) Cl Gas Lighter O Gas Log ❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Homp replacement 91 Roofing 0 Sewer Line 0 Photo -voltaic ❑ Ventilation ❑ Water Heater ❑ Water tine ' D T*x d/Pellet Stove (must be EPA certified, provide make, model and manufacturer). i Complete all applicable information on the ap0loation. incomplete applicadoneh will not be accepted. Application # Date J�>I V L% ford use only T lob Slta Addresys�(rer)raR9d1 Vahie of Cardil uctim (labor, mabertais, prom) 25 Iy,• .G .. I l WWM�� Property Owner Name Address City/Sft zo Phone C Cd Applicant Name Address City/State Zip Phone , Conb-cm W Address CITY/fie Zip Phone Contractor aty of Ft. Collins Sales Tax # Are you pairing fazes here or by report? N Here 0 Report -Wo&xnranbwIs raWheday Vwmacars. Are you payintg with your M&aacotatt? ill Yes ❑ No g5L39 Is this a residential or commercial project? 0 Rr If residential, is It P Single Far*/ Detached Cl Multifamily (apar>nher►t) If commercial, is it. C3 Bank E3 $or O Church ❑ Restaurant © Other (e Is this building 60 yews of age or more? Ll Yes If this is fthr a demolition permit, what year was Ifpforto 1975, you wN jxwd &7 atzbesft assww Description rof Work *If lawn sprinkiw/back1low preventer, must dst licensed Subanntractors: W dze = p9n Aww or aly off? 4 ential 13 Commerciial I Condotftmnhane (single family attached) ❑ Duplex. Garage Hotel/Motel ❑ Medial office 0 Omoe 13 RzteN . If first-ftme A/C, must tilt licensed elachidan. 8eMVW irlumber ; Mechanic 8aofer —1 .... Other I hereby admow,WW that I have read this application W state that the above kftmwtion is mvkke and col, I agree to comply with all requirements contained herein and cry oidinanees and sorbs laws ream ti V bull ft construction. x larow am a permit is not valid until It hale been paid end teams$. I, plicaft- pprintNawoe �t5b(P� �_ �1b'NeN 'e • - DateI7 I 170i 4- ZOO