HomeMy WebLinkAbout5212 Parkway Cir W - Applications/Reroof - 09/05/2014Sep 0514 07:34p
PA 1
Fort Collins
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). ❑ Air Conditioning
❑ Demo!ition (interior non-structural) 0 E;ectrical Alteration (not service change) 0 Gas Lighter ❑ Gas Log
❑ Heatira unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewar'Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line p Wccd/Pellet Stcve (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application Date
For ofnce use only
Job Site Address equreo)
0104
Value of Construction (labor, materials, profit)
. cam
ProperLy Owner Name
Address
City/State Zip
Phone
AppIcant Name
L,
Address
(State � Zip
Phone
-
___ e S 11 5.
c r
_ 27L610 -/8
Contractor
Address
City/State Zip
Phone
C=ractor City of Ft. Colli
s 5a es Tax
Sa(E�taxnun beris;equired by a!! ca^baCors.
q00 T7
Are you paying with your trust account?
i 4es ❑ No
Is this a residential or commercial project? 4 Residental' ❑ Commercial
If residential, is it: R�Zingle Family Detached ❑ Condoltownhome (single fami!y attacbed) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, Is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this b ilding 50 years of age or more? Yes r No IF yes, you may need to contact!-listor-cPreservaG'on
If this is fora demolition permit, what yearwas the building constructed?
£f pdor to 1975, you will need an asbestos assessment to submit I'dth this application. CO
Description of work �_or
1-14
4111 G ,Jew4
tIf lawn spr nMer(backflow eventer; must list licensed plum er. ' first i. e A/C, st list licensed electrician. site
Subcontractors: List the company name or Ciry cf Ft Colin license
Electrician Fumber flechar.ical Roofer Other
i
1 hereby acknowledge th2t 1 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 construdJon. I know that a
permit is not valid until it has been paid and issued.
Applicant l i 1�
Print P1ame: 0 h �lJ
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