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HomeMy WebLinkAbout1019 Kremmling Ln - Applications/Reroof - 10/06/2014it,,, WII.yf r Planning, Development & Transportation 281, N. College Ave P.O. Box 580 Fort Collins, CO 80524 Phone 970-416-2710 Fax 221-6134 This application is tOVbe tERsed f THEapply oCOUNTER PERMITS ONLY owing permits only (chock all that apply). O Air Conditioning [ 1 Derrlolition (interior non•structim9lj O electrical Alteration (not f .ie© change) O Gas Lighter O Gas Log I� h101riting Unit 1_I Lawn 3prinklier Cl Mobile Home roplacr3ment ! cl:,, ❑ fiewer Line O Photo -voltaic ni nill'Al uro I� W it pteetor I� W strir lino L Wood/i�ellet Stov {must lwr EPA certified, provide make. model and mrrm I Fncturrtrj. Comploto all applicable information on the application. Incoinpleto applications will not be accoptod Application 4 7 jDGf�—o�_ 1•nt al%tea urr, only Job Site Address (ra7ulnw) r er-41, M M, Property Owner Nan Applicant Name / Contractor Contractor City of Ft. Collins 5a/1.1; tax number is required by all Address Address .-•r � ✓ �, f. ion,,, -. Address Date /0 U� Value of Construction (labor, materials, profit) 1100 City/State zip Phone ,v-% r6-160 `dus2(o illy -IL/fq City/State Zip Phone / n City/State' Zip Phone Tax # Are you paying taxes here or by report? ❑ Here O Report >xs. Are you paying with your trust account?,,O`Y"es O No Is this a residential or commercial project? ,[a Re-sidential ❑ Commercial If residential, is it: a Single Family Detached ❑ Condo/townhome (single family attached) 13 Duplex ❑ Multifamily (apartment) ❑ Garage If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel '❑ Medical office ❑ office C3 Retail ❑ Restaurant ❑ Other (explain) Is this building 50 years of age or more? Okyes ❑ No If yes, you may need to ContbctH&totiC preservation If this is for a demolition permit, what year .was the�building constructed? Ifpnor to 1975, you will need an asbestos assessment to submit with dris app/rcalion. Description of work , .. T 7/- . % *If lawn sprinkler/badcFlowpreventer, must list licensed*plumber. Iffiest=tini Subcontractors:List the company name orCilyofFtColllnslicense# electrician. Electrician Plumber Mechanical Rooter 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: /rril -+ t i,• ~ Print Name. ,_ .,`i , Signature ..s �` _/�. c`�.3;� r1 _%�%t✓�-� Date 0 (Q