HomeMy WebLinkAbout2603 Paddington Rd - Applications/Reroof - 09/10/201409-10-'14 14:31 FROM -Premier Hoofing
Fort Collins
9704848308 T-221 P0007/0008 F-442
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
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). ❑ Alr Condkioning
p Demolition (interior non-attuctural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter 13 Gas Log
0 Heating Unit 13 Lawn Sprinkler (a Mobile Home replacement 0 Roofing M Sewer Line ❑ Photo-voltaio
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA cerlified, provide make, model and
manufacturer).
Complete a pp11 able!infor information on t e app%l�icatl n. Incomplete applications will not be accepted.
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Job Site Address &vulmd)
Value of Construction (labor, materials, profit) L,
Property Owner Name
Address
City/State Zip Phone
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Applicant Name
Address
City/State Zip Phone
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Contractor
Address
City/State Zip Phone
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Contractor City of Ft. Ca ns Sales Tax #
Are you paying taxes here or by report? 811 re ❑ Report
saiesraarnumber&mqulIWby811Wno-ado s
Are you paying with your trust account? 0 Yes ❑ No
Is this a residential or co erdal project? Rle-sidential 13 Commercial
If residential, is it: Mingle Family Detached ❑ Condo/townhome (single family attached) O Duplex
0 Multifamily (apartment) 13 Garage
If commercial, is it: E3 Bank ❑ Bar CI Church O Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant 13 Other (explain).
Is this building 50 years of age or more? ❑ Yes o Ifyes, yaumayneeddocontadHrsmrscPreservadcn
If this Is for a demolition permit, what year was the building constructed?
lfpriar to i975, you w/Oneed an asbestos assessment to subm/t w/lh this appl/caft
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*If lawn sprinkler/backflow preventer, must list licensed plumber, If first-time A/C, must list lcensed electrician.
Subcontractors: UsttheaompanynameorCilyofFtColrnsllmnsop
Electrician Plumber Mechanical koorer 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 pald and issued.
Applicant:
Print Name: L J177T! I n LL Signature
Date M -10 -1►11
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