HomeMy WebLinkAbout7257 Fort Morgan Dr - Applications/Reroof - 10/13/2011n•
V
Pla rang, Development &Transportation
O 281 N. College Ave P.O. Box 580
.:. cart �fl. airy Fort Collins, co 80524
10
Phone 970-416-2740 Fax 224-6134 4 • / _ r�wL
OVER-THE-COUNTER PERMITS ONLY OP -
This application is to be used to apply far the following permits only (check all that apply). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit O Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ 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 # t �q DO Date
For office use only
Site Address (requ/md)
Value of Construction (labor, materials, profiq
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or
D11iM 062s A7o
225-q'16a
Property Owner Name
AddQs '
City/State Zip
Phone
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klit, # 5 &Dnrn '-e
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Applicant Name
i
Address
City/State Zip
Phone
Contractor
Address
City/State Zip
Phone
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? Here
❑,Report
Sales tax number/srequlmd by allcon&vc(tms
Are you paying with your trust account? ❑ Yes
Yj No
Is this a residential or cpri+merclal project? Crikesidential ❑ Commercial
If residential, is it: 0 Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, Is It: ❑ Bank ❑ Bar' ❑ Church ❑ Hotel/Motel ❑ Medlcal office ❑ office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No If yes, ynu mayneed to contact Historic Preservatlon
If this Is for a demolition permit, what year was the building constructed?
Ypnor to 1975, you wi/l need an asbestos asmmment to submit with this appllcabion.
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subtoetractors: List the company name of Q•Ly of Ff Collins license # �/
Electrlclan Plumber Mechanical Roofer ' / 5 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 dty ordinances and state laws regulating building construction. I know that a
permit is not valid until It has been paid and issued.
Applicant:
Print Name: eI1M V11� Date �_ Signature �
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