HomeMy WebLinkAbout731 Morsman Dr - Applications/Reroof - 08/21/2014From: All Phase Restoration Fax: (970) 622-2057 To: Fax: +1 (970) 224-6134 Page 1 of 1 08l2112014 2:33v9
Cit
F�y 11 I Planning. Development & T
,s01 `COII��.� 281N.Col"�etation
Fort Collins, Avego524 P.O.0Box 580
Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This application Is to be used to apply for tha following permits only (check all that apply). ❑ Air Conditioning
D Demolition (interior non-structural) ❑ Electrical AftMOon (not service change) O Gas Lighter ❑ Gas Log
D Heating.Unit ❑ Lawn Sprinkler ❑ Mobile Homesepiacement)Aoofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation 0 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.
Applicati1 on # j�! VV� D S Date S-2 /- I ef
For ofce use oNy
Sob Site Address (re ju md) Value of Constructionabor
Q , materials, prom)
! en 1 l-er(-L_ff..JraS.i is l o
Property Owner Name Address City/State Zip Phone
n �w 11. to eS26 ro- 2 o S7
Applicant Name Address 6ty/State Zip phone
400 /n
i C9 >��
Contractor
Address Oty/State 7
/�//PliccSG .�4s�'r'al<ijyvh 355 Greenri'rJ e %d 5/i P LI/i��SoCU doss
Ph
Contractor City or Ft. Collins Sales Tax # Are youpaYrn9 taxes here or b report?
s�r�rarnr mas nrepuiiedoyaaano-arnxs Are you paying with your trust -account? yes e XNo Report
Is this a residential or oommer ial.project7 J°'t Residential ❑'Commdrdal
If residential, is it: r��(Single Family Detached ❑ Condo/townhome (single family attached) Cj Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: 0 Bank L3 ft ❑ Church O Hotel/Motel ❑ Medical office 17 Office ❑Retail
❑ Restaurant ❑ other (explain)
Is this building so years of age or more? ❑ yes XNo Ifyes,. you mayneW to m0b&flistak P��
If this is for a demolition permit; what Year was the building wradructed?
Ifpnbrto 1975, you IV&need an asbestos amsrnenttosubmit with th/sappUcation.
work
*If lawn sprinkler/badtflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
List the mmpanynameorCltyofFtCo/Uizs/icrnM,f
Electrician Plumber Medranlrai`__ Roo/er
that I have read this
comply with all requirements tained.h eand licati� �d state that the above information is complete aid correct I agree to
permit Is not valid until It has peen paid and Issued, ordinances and state laws regulating building construction. I know that a
Applicant:
print Name: signature _ —
Dam