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HomeMy WebLinkAbout433 Peyton Dr - Applications/Reroof - 06/14/2012Jun 141211:26a p.3 C -tY.Of Uns Planning, Development &'Transportation 281 N. CoAege Ave P.O. Box 580 Fort Collins, CO 80524 Phone 970-416-274D Fax 224-6134 OVER-THE-COUNTER PERM17S ONLY This application is to be used to apply for the following permits only (check all that apply). 17 Air Conditioning O Demolition (interior non-structural) ❑ Electrical Alteration (not service change) Q Gas Lighter ❑ Gas Log CI Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement 0 Roofing ❑ Sewer tine ❑ Photo -voltaic .0 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?I 31 Date rorof a tcse only lob Siite Address CmgL redj Value of Construction (labor, mauls, profit) Property Owner Nami Address City/Stage Zip Phone 4'70 1-414eI Ile r-�o(1 54 Cm (ins Co BvSa S `Applirant Name Address City/State Zip Phone r17 D Z T ' C 80 2. Zo-1- ;Canbactor Address City/State Zp ! Phone 'Contractior City of Ft Collins Sales Tax # Are you paying taxes here or by report? E3 Here 0 Report aIMtaxnamverrsrE7j&adbfarirnntractam Are you paying with your trust account? ❑ Yes ❑ No pis this a residential or commercial projecC? ■ Residential ❑ Commercial rif residential, is it: 0 mangle Family Detached ❑Condo/townhome (single family a#kached) ❑Duplex ❑ Multifamily (apartment) ❑ Garage If commerdal, is it: ❑ Bank ❑ Bar ❑ Church © Hotel/Motel ❑ Medical ottice ❑ Office ❑ Retail 0 Restaurant ❑ Other (explain) Is this building 50 years of age or more? ❑ Yes O No Ifyes, youmayneed to contactHls mkPreseruatfon =IF this is for a demolition permit, what year was the building constructed? Kpriorto 1975, you agneed an as4estrw assessrnentto sabmlt x+Jfh fhis appllcarfon. Description of workeas S on'"s e• p e!c'i s fbo rr lu't4- /( 9 S)o uarPs Caw%60S-d-Flo+- i !',*If lawn sprinkWffiack loro preventer, must Fist licensed plumber. if first-time AX must fist Aoensed electrician. :*Subeontraitors: ListthemmpanynamsorayofFi'Cofft'nsll4sase# 6echidan Plumber Medianica1 Roofer. Other. I henry admovOedge 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 anA state laws regulating building construction. I know that a permit Is not valid until it has been paid and issued. Applicant: i Print Nam