HomeMy WebLinkAbout1803 Churchill Ct - Applications/Reroof - 07/16/2012Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone970-416.2740 Fax224.6134
OM -THE -COUNTER PERMITS ONLY
This application is to be used to apply for the fallowing permits only (check all that apply). ❑ Air Condti
O Demoftion (interior non—structural) O Electrical Alteration (not service change) 0 Gas lighter 6 Gas Log
• Heating Unit ❑ Lawn Sprinkler 13 Mobile Home replacement XRoofing ❑ Sewer Una 0 Photo -voltaic
• Ventllatipn 11 water Heater M Weber line C] wood(Peftet Stove (must be EPA certified, provide make, mo
menufactuter).
Complete Ill applicable information on the application. Incomplete applications will not be accepted-
3 g'
Application # �� Date 111 �(D012 110
rvrdrw use only -
lob Site Address fraquftd)
Value of Construcdon (labor, materials, profit) s1000
QM IMA QL12-
CAAVVCVIW40 UrOJO 7-177-1 QISG
Property Owner.Name
Address City/State Zip Phone
I
Applicant Blame
Address Gty/State ZIP Phone �-
Cordracmr
Address aty/State Zip Phone
. I
2%-W 1'0A'1L AW. M r1V4r IQOIm $oe�II:tt3
ContrectorCity of R. Collins Sales Tax # Are you paying razes here or by report? 31fHene n R* t .
Are with trust account? 0 Yes 111614
sefas&?ro bye can&adum
you paying your
Is this a re*entW or commercial project?. )KWdentlal ❑ Commercial
If residential, is it- 0 Single Family Detached O Condo/townhome (single family attached) 0 Duplex i
C] MuMimly (apartment) ❑ Garage !
If commercial, is it: O Bank 0 Bar ❑ Church 17 Hotel/Motel ❑ Medical office O Office ❑ Retail
0 Restaurant 0 Other (explain)
Is this buikflng 50 years of age or more? ❑ Yes pKi5o If yes, you may Iv ed to contact i mtmr Pfrsemffvn
If -this Is for a demolition pencil; what year was the building constructed? I
If: prior iv 1.94 you oR need an asbestos assessment to submit *0 bhfsayp/mdion.
M
*If lawn sprinkler/baddi m prevent2r, must rist licensed plumber. If fb*b re A/C, must UA Ikwsed electrician.
Subconbadors: Lfstthecnln MYMMorCRY OFM b®asRc nw #
Eledri®n PWmber Mechanical Roofer �frlp Other,^
I hereby slow $edge that I have read this application and state that the Iril'orrratiwr is complete and correct I agree to
compiy wWr all requirements contained herein and city orciblancesanAA10111laws 8 buiding construcWn- I know that a
permit is not valid until it has boon paid and lowed.