HomeMy WebLinkAbout2937 Brookwood Dr - Applications/Reroof - 10/21/2011Oct 21 11 02:11 p Westers Roofing
City of
9705688448 p.6
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 ❑ Roofing O 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 �0
For o� use ony
]ob Site Address (required)
Value of Construction (labor, materials, profit) .
GQO
Property Owner Name
Address
City/State Zip Phone
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Applicant Name
Address
/State Zip phone
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ContractorL
Address
City/State Zip Phone
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Contractor Oty of Ft. Collins
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Are you paying taxes here or by report? ❑ Here Ot Report
saesraxrrumberlsrMu/redbyall
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Are you paying with your trust amount?,$.Yes ❑No
Is this a residential or commercial project? -A Residential O Commercial
If residential, is it: .Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
CI Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes AJLNo If yes; you may need to contacYNrstoric Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will needan asbestos assessment to submit with this application.
Description of work
*If lawn sprinlder/back low preventer,•must list licensed plumber. If first-time A/C, must list ' nsed.electrician.
Subcontractors: List the company name or Gty of Ft Coffins license ,Y
Boor+dan Plumber Mecirarical Roofer Other
I hereby acknowledge that 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 ating budding construction. I know that a
permit is not valid /flluntil it has been paid and issued.
Applicant:
Print Namm e: VVII g JO/.G` A. L'5k-! 5i nature r
Date