HomeMy WebLinkAbout1601 Tanglewood Dr - Applications/Reroof - 07/18/2014OVER THE-COU. NTER FERMI-1-b UMLT
This, application is to be used to apply :for the following permits only(check ail that apply). ❑ Air%Conditioning;
d Demolitwn (interior non-structural), ❑ Eiecirical Alteration (not service change) ❑ Gasiighter fa Gas Lgg
❑ Heating Unit . ❑ Lawn Sprinkler ❑ MobIWHome replacement RooRrig ❑ Sewe'r true ❑Photo voltaic
❑ VenGiation ❑ Water Heaier.,O Water Line. ❑ Wood1Pei!et'Stove (mubibe &Acertified, providemake model and
manufacturer),
Complete all applicable information` on the application. incomplete applications will not be accepted.
Application # �1+D
For efi9re use Only
Date
Job Site Address (ie4ulrad)
tests, proflt)
Value of Construction (labor,.materials,
V co-x
k .k�)O0 cZ
Property Cvmcr Name
Address Gty/State Zip Phone
Applicant Name
Address Gty/State Z'ip Phone q -70 -
•Contractor
Address. iy/State Zip Phone
Contractor Qtyof Ft. Collins Sales Tax Are you. paying taxeshere or by report? i°f�e ❑ Report
Are you: paying rvithyour trustaccbunt? tHYes 0No
esrax,�untraris�ecuved6ya•7aua�mrs
Is this•a'residentiai or commercial project? gr Residettial' 0 Commercial
If residential, is It M sitrgle Family Detached ❑ Go I.,
. me (single family attached) ❑ Duplex.
❑ Multifamily (apartrrient). ❑ Garage
If commercial, Is ❑ Sank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical;office_ 0 office ❑•Retail
❑ Restaurant ❑ Other (explain)
Is this building 5tl years of age or more? I7 Yes ❑ No 7f yes, yvu mayneed to cont=Hfslvric Przservadon
if this is fora demolition permit, what year was the'building consir6 twd?•
Ifpriorto.19n,, you will need.`an `asbestos as'sexsment to submlf kNO bV,!s app6catron.
k,
Work
*If lawn Sprinkler/baddtow preventer, must lit licensed plumber. If first-time A/C, must,list licensed electrician.
Subcontractors: L`srthe aimmpgny"naine,orC ty-ofR'Co(linsliccnsn s;
Plumber Mechanical :Roofir`R-'1$59" ;Other
I herebyacicnowledge that I have; read this application and state that the -above information is complete and corre2 I agree to
comply with all requirements contained herein and city ordinances land stateiaws regulating building tonstructlon. I know that a
permit is not valid until it has been paid and issued. '
�r
Applicant:'
Print Name: ��r'^ J 2.1nvr l Yt S. signnture�