HomeMy WebLinkAbout1327 Armsley Ct - Applications/Reroof - 08/29/2014City of Planning, Development & Ti transportation
281 College Ave P.O. Box 580
F®rt Collinsrt�s 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 served change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement 0"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 # 45MU� dot Date "I 1
For office use only
Job Site Address (required) j Value of Construction (labor, materials, profit)
Property Owner Name Address City/Statep4t6i A.A Zip '919SDPhone T 0
�44� UA �k,clt�c,.
C-66..r4 C �..rIIL CiG a�sb
Applicant Name Address
f' 3- Iv1 31 �_6 '� 'W
Ci /State Zip
�r s� 6 _ ��SC
Phone
03-w --S' E-s
Contractor LL Lic # Address h
( City/State PL. Zip
0 Phone
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here &M- epdrt
sales tax number isrequired byall contractors
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or commercial project? �9 Residential ❑ Commercial
If residential, is it: ❑ Single Family Detached N Condo/townhome (single family attached) Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
Cl Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes 9 No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If. prior 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 f
Electrician 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: /3 r��f
Print Name: '� o Signature Date U G
\ - 4 4� P)
L 1