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HomeMy WebLinkAbout608 Peyton Dr - Applications/Reroof - 07/12/2012Jul 121211:02a p.3 FCilirt Collins /�� Planning, Development & Transportation 281 N. College Ave P.O. Box 580 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 ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and manufacturer). Complete all applicable information [ aatioonon the application. Incomplete applications will not be accepted. � Application # _ _ _ �� Vqf R(V Date For ofllce use only Sob Site Address (required) Value of Construction (labor, materials, profit) 608 'gyp. ` D t a 300.00 Property Owner Name Address City/State Zip Phone q-76 TZ \ 2ic�vter Somme r Co 3o5a Applicant Name Address City/State Zip Phone 4'7cs a'ra"e E&0� I�22S - �0 7�oocF Contractor J Address City/State Zip Phone 5(-- +»%-.— Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report sales raxnurrberisrcqukedbyaecarbactom Are you paying with your trust account? ❑ Yes 0 No Is this a residential or commercial project? tM Residential ❑ Commercial If residential, is it: ® Single Family Detached © Condoltownhome (single family attached) ❑ Duplex ❑ Multifamily (apartment) ❑ Garage If commercial, is it: ❑ Sank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail ❑ Restaurant ❑ Other (explain) Is this buildng 50 years of age or more? ❑ Yes d No If yes, you may need to contact Historic Prese`rvatlon If this is for a demolition permit, what year was the building constructed? ifpdor to 1975, ynu will need an asbestos assessment to submit wick dris application. ition of work 3 Sgvar�t C'vKn; to *If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician. Subcontractors: List the company name or Clly of R Colrrns 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 mnstrucion. I know that a permit is not valid undi-it has been paid and issued. Applicant: i't11tI ^i��l.�'I.LL1P,.' Signature 11�t';'�! Date Print Name: