HomeMy WebLinkAbout5006 Redbud Ct - Applications/Reroof - 06/21/2012Planning, Development & Transportation
Cif of 281 N. College Ave P.O. Box 580
-Frt Collins Fort Collins, Co0524
o
o Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). 0 Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
q Heating Unit ❑ Lawn Sprinkler 0 Mobile Home replacement ❑ Roofing O Sewer line Cl Photo -voltaic
fl Ventilation ❑Water Heater o Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information
ti_ on the application. Incomplete app catio will not i iaccepted.
Application 102 ULL�qDate
For office use only
Job Site
Value of Construction (labor, materials, profit)
$
A re_ss City/State Zip vnone
property Owner Name �j� /� %� �/���J
r _ — i QYn �\ nL '1mot'o—, W Z-L/�7Cil�
ter-
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WED z I Phone
city/State ZIP
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- — - ".0 ;.
Contractor City of Ft Ins Sales Tax # Are you paying taxes here or by rdport?)W-lere Report
Are you paying with your trust account? ❑Yes No
sales tax number is eequlmd bya#mntradors.
Is this a residential orommercial project? Residential ❑ Commercial
❑
If residential, Is It: .w ultl Ingle Fa ly Dertmen) ❑ Condo/townhome (single family attached) Duplex
Garage
If commercial, is it: E❑i MBank ❑ Bar r3 Church ❑ Hotel/Motel 0 Medical OfFlce ❑ Office C] Retail
Cl Restaurant ❑ Other (explain)
Is this building 50 years of age or more? M Yes O No If yes, you may need to contact HlstVdc PreservadOn
If this is fora demolitionyouwilleed permit, what
year
to subml�wl�ths application.
If prior to 1975, 3'0
work
*If lawn sprinkler/backfiow preventer, must list licensed plumber. if first-time A/c, must list licensed electrician.
Subcontractors: List the company name or CityOfftCo/llns license #. r, i , „ other
Electridan
Plumber Mechanical Roofer -r�=�s ,,�=p—
L 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 contalned 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.
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Applicant: Signature Date
Print Name:
I'd SOOGL92OLS OWI 9WId008 SOOI1 WdLE=E 2102 la unr