HomeMy WebLinkAbout2456 Marquette St - Applications/Reroof - 06/15/2012F0 go 677
City of Planning,, Developmnt eR Transportation
F�.{.281 N. College Ave P.O. Box 580
� Collins Fort Coffins, 00 80524 U 1
Ph" 970-416-2740 Fax 224-6134 V,
OVER-THE-COUNTER PERmrrs ONLY
This application Is to be used to apply for the following permits only (check all that apply): ❑ Air Conditioning
❑ Demolition (interior non-structural). ❑ Electrf6al Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
Q Heating Unit ❑ Lawn Sprinkler Q Mobile Home replacement ❑ Roofing C] Sewer Line ❑ Photo-vottaic
❑ 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 # �� �cL-17— Date
For &Ike use avrly
Sob Site Address (re4u1� Value of Construction (labor, materials, profit) .
Property Owner Name Address City/state Zip Phone
2u�1� a'o
Applicant Name Address City/state Zip Phone
Contractor t.tc #A .267 Address City/State Zip. Phone
Conmactor City of Ft Collins Salek x # Are you paying taxes here or by report? ❑ Here ❑ Report
S.zw taxaunbir& MqATdbyaff=Vararrs Are you paying with your trust account? ❑ Yes .❑ No .
Is this a residential o mmerdal project? J�Resldenttal ❑ Commercial
if residential, Is it: Single Family De ❑ Condo/bownhome (single family attached) ❑ Duplex
0 MultlPamily (apartment) ❑ Garage
If commercial, is It ❑ Bank 13 Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explaln)
Is this building 30 years of age or more? ❑ Yes G No Yyes, you cosy need m contct Hoc Preservation
If this is for a demolition permit, what year was the building constructed?
Ypnbr to 1975, you w111 need an asbestos. assesYrent to submit WIM Oh1s appl/cablon.
Of
*If lawn spdnkier/baddlow preventer, musf list licensed plumber. f first-time A/C, must Ildkensed electrician.
Subcontractors: List the company name or CXy ofR Co//= /kense ,:E
9ectrkian Plumber Mechanical Reofer Other
I hereby adomwledge. 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•tt has been paid and Issued.
Applicant
Print Name: r'4o46 Signature