HomeMy WebLinkAbout525 Albion Way - Applications/Reroof - 10/02/2014City
Wt Colh ns
of
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) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement %goofing ❑ 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 # gJLM331 Date
For office use only
Sob Site Address (mqulied)
5z5 141blOAl Gtl
Value of Construction (labor, materials, profit)
06i6//,tYS ROWS
Property Owner Name
Address City/State Zip
Phone
Applicant Name
Ike �a�#e
Address City/State Zip
Z 3 A/ Ue e, de Stt Zoo R)EL
Phone
9-70 V- 9210
Contractor
tile, Ins
Address City/ fate Zip
Uohbd AnC, N rve
Phone
Contractor (Sty of FL Collins Sales Tax # Are you paying taxes here or by report? ❑ Here 10 Report
saps 1�� ,redbyaucartract Are you paying with your trust account? Yes —Pdo
Is this a residential or commercial project? t&esidential ❑ Commercial
If residential, is It: gle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
13 Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes o If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was tKe building constructed?
Ifprior to 1975, you will need an asbestos assessment to svbm/t wlbh this application.
Description of work 1 eai- F TO - �
sruq
*If lawn sprinkler/baddiow, preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or Oty of Collins license #
Elecbidan Plumber Mechanical Roofer lotl.S .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: Z5
Print Name �^' Signature � Date
I