HomeMy WebLinkAbout3013 Tulane Dr - Applications/Reroof - 09/17/2014Fort 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
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement )j 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 # „f r&1^0 8 q�- Date 7`
For office use only
Job Site Address (required)
�013'`ula.►�. DY �
Value of Construction (labor, materials, profit)
. Uv
Property Owner Name Address
City/State Zip
Phone
t . 114 f0hVIS
Co 8ilti25
01-ID16-
Applicant Name Address
City/State Zip
Phone
IID
v CD `d 25
ft JqTZ6Z
Contractor Address
k6 So.l . l
City/State Zip
4. W11M CD 25
Phone
CUP-61-25D
Contractor City of Ft. Collinsiales Tax #
Are you paying taxes here or by report?
Here ❑ Report
sal.yaxxnnuummbeer is required by all contractors.
bSD
Are you paying with your trust account?
Yes ❑ No
Is this a residential or commercial project? 95
If residential, is it: Single Family Detached
Multifamily (apartment)
Residential ❑ Commercial
❑ Condo/townhome (single family attached) ❑ Duplex
❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (ex lain)
Is this building 50 years of age or more? ❑ Yes No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If pnor to 1975, you will need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license #
Electrician Plumber Mechanical RooferZ-1A11 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: mow, " 66 /A�"
Print Name: iI \r S Signatur Date 0,111A