HomeMy WebLinkAbout2737 Coal Bank Dr - Applications/Reroof - 08/27/2014ForaColU s
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Planning, Development&Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
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 ice change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement Roofing ❑Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stov (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application #__ ZI4-0-P0ffio Date
For ohrce use only
bob Site Address (required) Value of Construction (labor, materials, profit)
ZA737 r-oat RayiLc_ 5i�
Property Owner Name Address City/State Zip Phone
1cWi'v, - Son _�-73'7C (C co DrZS" l O -ZGb _ 023 f
ApplicantNameAddress City/State Zip Phone
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Contractor' City/StaeS
Address Zip Phone
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
Sales taxnumberis required byall contractors. Are you paying with your trust account?,EDT-es ❑ No
Is this a residential or co lercial project? X
If residential, is it: Single Family Detached
❑ Multifamily (apartment)
If commercial, is it: ❑ Bank ❑ Bar ❑ Church
sidential ❑ Commercial
❑ Condo/townhome (single family attached)
❑ Garage
❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No If yes, you may need to contactHistor/c Preservation
If this is for a demolition permit, what year was the building constructed?
Ifprior to 1975, you will need an asbestos assessment to submit with this application.
Description of work
❑ Duplex
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*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or Crty ofFi-Collins license #
Electridan 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 regulating building construction. I know that a
permit is not valid until it has been paid and issued.
Applicant. /)!fi
Print Name:V I� s r�fi�i^ Y signature �9 N' �f: �%�c%`_ l %%� Date 1 2 11