HomeMy WebLinkAbout4407 San Remo Cir - Applications/Reroof - 06/18/2012., `05(c�Ah fEll:w{r Dso;ads i�,^. i.1 `.'7,iAt.
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Fort Coilins, CO &"52
P hol is 97./-�Ia J"c.J-rl. S=a:i a._ '+7I.41OVER-THE-COUNTER PERN11
This application is to be used to apply for the following permits only (0,ock all that apply), 0 Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ 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 #8/,)-p ��_ Date
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
0-1 San n Q rcl Q �
Property Owner Name
Address
City/State Zip
Phone
ChYi S Ohaac&- (4
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R Qrnt) u c y7-1- co l l v►1S
Applicant Name
Address
City/State Zip
Phone
Contractor Lic # R) r / Address
City/State Zip
Phone
_" 4-P_ s a RCQ�q r%
1050 W_
-we . 70211 3
Contractor City of Ft. Collins Sales Ta
#
Are you paying taxes here or by report? KHere
❑ Report
Sales tar number& required by all contractors.
Are you paying with your trust account? ❑ es
XNo
Is this a residential or commercial project? Residential ❑ Commercial
If residential, Is it: `nksingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar 17 Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes )!�Vo If yes, you may need to contact Historic Preservation
If this Is for a demolition permit, what year was the building constructed?
If pr1or to 1975, you wlll need an asbestos assessment to submit with this application.
Description of work .1�)c_
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the companyname or Co of Ft Collins license #
Electrician Plumber Mechanical Roofer 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: -
Print Name: Signature Date (D - "�