HomeMy WebLinkAbout1137 Doral Pl - Applications/Reroof - 09/21/2011City of
��1rt CoLLIns
Planning, Development &Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 22+6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
❑ Demolition (Interior non-structural) ❑ Electrical Alteration (not service change) D Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement 411tooflhg ❑ Sewer Llne . ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line 11 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.
Application # fa-l)01.5 n 11F"d Date-`ZIP�t
For offtV me on/y
lob Site Address (rm v1W)
Value of Construction (labor, materials, prom)
w�lOo\\M
&gas -
Property Owner Name
Address
1 City/State Zip
Phone
Apr" :rt Name
Address
City/State Zip
Phone
ntractor
Address
City/State Zip ff �
�`ovCl�ln(tF�
ne ,
Contractor City of Ft. Collins SAS
Tax #4 G 38
Are you paying taxes here or by report?vd-here
❑ Report
safes tar mmnaernre0redbya#cono"acmrs
Are you paying wlthyour trust acoounCk9il'fes
❑No
Is this a residential or commerclal project? WResidential O Commercial
If residential, is it Mingle Family Detached ❑ Condo/townhome (single family attached) O Duplex
13 Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church 13 Hotel/Motel ❑ Medical office 0 Office O Retail
❑ Restaurant ❑ Other(explai
Is this building 59 years of age or more? 0YeszANo. Ifyes, you mayneed to contact Historic Presenation
If this is for a demolition permit, what year was We —building constructed?
rfprfor to 1975, you W11 need an asbestos assessment to subm/t Wth this appllcabbo
Description of work N Q.mot1W- GLr i? EV O e Z 2Q. m S S�KKQ l�`�L4`�
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors:List theevownyname orOtyofR0707sfihr #
Electrician Plumber Mechanical Roofer Other
I hereby admowledge 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.
Applicarett ww JJ • ♦ r /'
print Name �//�0� `� (Xl f I'1 Signature J Date ' s