HomeMy WebLinkAbout2638 Country Squire Ln - Applications/Reroof - 09/25/2014City
f i Planning., Development
281
Box 580 ttVft�n5�Fort oIICO8052
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). ❑ Air Conditioning
❑ Demolition (interior non-structurao ❑ Electrical Alteration (not se ice change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ m Lawn Sprinkler ❑ Mobile Hoe replacement se
❑ 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 # Date I d
For A%64 rw only
Sob Site Address required
Value of nstnuction (labor, materials, profit)
8
t
(.t i m-L rico
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Property Owner Name
Addresd
City/State Zip
Phone
✓Yl l0
S nAVrl
piicant Name
Address
aty/state Zip
Phone
Contractor
Address
City/State
il one . T777
Q-154
w. 5- "Zi C-0
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Contractor City of Ft. Collins
Tax # y 0'5'� Are you paying taxes here or by report.
ere ❑Report
.sa�tax nianaersnquiredbyanconbacft7m
Are you paying with your trust account?
es ❑ No
Is this a residential or
,PQTmercial project? `3,51%dsidential ElCommercial
If residential, is it:.4a9ngle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If.commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 59 years of age or more? ❑ Yes ❑ No If yes, you may need to contact Hatorh:Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessrrrent to submit with thisapplkation
Description of work rieMQQQ— a.F-e-
*If lawn sprinkler/baddiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of R Collins Awnse #
Electrician Plumber Mechanical Roofer other
I hereby acknowledge that I have read this application and state that the above infonnadon Is complete and correct I agree to
comply with all requirements contained herein and city ordinances and state laws regulating building mrlstructim. I know that a .
permit is not valid until it has been paid and issued.
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