HomeMy WebLinkAbout2913 Redburn Dr - Applications/Reroof - 09/24/2014V�� Planning, Development & Transportation
FClty}Of 281 N. College Ave P.O. Box 580
OIrr` Colima 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 ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater [I Water Line ❑ Wood/Pellet S ove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # -1F_->A "t03650 Date
For owe use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
fir} t`pGvns (,v sos�
Property Owner Name
Address City/State Zip
Phone
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�� �� . ram 6 '6 W 5a5'
- 43—Ms6
Applicant Name
Address City/State Zip
Phone
Wlr• 6) �&1,,,; r. 5k FDA- I,r, (1) 5a5
303- %91- 315�
Contractor — (qy
Address City/State Zip
Phone
(Doael
)So- f' A, . SA C Lk\,r\ 8a5;z5 323-1I0-o85
ContraYctor City of Ft. Collins Sales Tax # Are you paying taxes here or by report?
❑ Here ❑ Report
Sales taxnumber isrequired byall contactors
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or co mercial project? )&
If residential, is it: � Single Family Detached
❑ Multifamily (apartment)
sidential ❑ Commercial
❑ Condo/townhome (single family attached) ❑ Duplex
❑ 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 XNo' 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 applicatlon.
Description of work ?,,P- - Z® A-o
*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 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: t
Print 4 Name: 0 r\ L Signature ` Date y