HomeMy WebLinkAbout3324 S Lemay Ave - Applications/Reroof - 08/25/2014Aug 19 1411:19a Northern Lights
303-774-1206 PA
City of Planning, Development & Transportation
281 N. College Ave P.O. Box 580
F6r 1.} Coth iS Fort Collins, CO 80524
`- Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply forthe following permits only (check all that apply). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not serves change) ❑Gas Lighter ❑Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement t 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 # � `� ®WI 'D 4�
For office use only
Date P) - 2 5— I Lf
lob Site Address (required)
Value of Construction (labor, materials, profit)
j Z-q 5. L�i,v. A v
Property Owner Name Address
City/State Zip 2052.'r Phone
Applicant Name Address
City/State Zip Phone
Contractor Address
City/State Zip Phone
o ¢FK 9)4-edors I13
hJ 23 F-4- LL k-- o 0C2, 303 -776 :S26
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here ❑ Report
Sales tax number is required by all contractors
Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or co
nnercial project? VResidential ❑ Commercial
If residential, is it: M Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office 0 Office ❑ Retail
❑ Restaurant ❑ Other (explai
Is this building 50 years of age or more? ❑ Yes 121No If yes, you mayneed to conbcCHistoric Preservation
If this is for a demolition permit, what year was the building constructed?
rfprior to 1975, you W11 need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinklerlbackflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
SubcontractoFs: Listthemmpanyname orCity ofFtCollins license #
��r:
gectridan 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:__ _ �' ``-6LV Signatu Date �� <<