HomeMy WebLinkAbout1514 Luce Ct - Applications/Reroof - 07/06/2012City of ^� Planning, Development & Transportation
oege Ave P.O.
Fart Collins i \ Fort Co281 N. Cns O 80524 Box 580
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) 0 Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicabla,Informatio on the application. Incomplete applic io will not be accepted.
Application # ICKU 9 Date
For ofl9ce use only
Job Site Address ( red) Value of Construction (labor, materials, profit)
15\ $ _ex_�
P -� caner ame Address
City/State Zip /
ii/'
Phone
U2;6i
;rl All
Applicant N Address
City State Zip
Phone
_
Contractor Lic # Address
City/State Zip
Phone
Contractor City of Ft CJIns Sales Tax #
Are you paying taxes here or by r6port? $Diere
Report
alw4wnumber isrequIredbyall mn&actom
Are: you paying with your trust account? ❑ Yes
�No
Is this a residential or commercial project? Residential ❑ Commercial
If residential, is it: O Single Family Detac ed C] Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) 0 Garage
If commerclal, Is it. ❑ Bank ❑ Bar C] Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building So years of age or more? ❑ Yes I7 No If yes, you may need to contact Histodc Preservaffon
If this Is for a demolition permit, what year was the building constructed?
If Pr/or to 1975, you W11 need an asbestos assessment to submit with this applicamon.
work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: U& Me companynameor City of Ft C01/1n5!/M7Se 0
Electrician Plumber Mechanical Rooferk WRI Other
I hereby acknowledge
comply with all requlr
permit Is not vall
Applicant:
Print Nam
I have read this application and state that the above Information is complete and correct. I agree to
is Contained herein and dtY ordinances an5l tate laws regulating building construction. I know that a
It has been paid and is
7
Sig ture
i
Date
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