HomeMy WebLinkAbout5451 Golden Willow Dr - Applications/Reroof - 12/11/2014Dec 23 14 02:14p Tony
City of
1-970-669-5999
Plannine- r*av=tnn..,a..t o_ a
p.2
Fort
281 N. College Ave' P.O. Sox 580
ins
Fort Collins, CO 80524 i
�-
Phone 970-416-2740 Faz 224-6134
OVER-THE-COUNTER PERMITS ONLY
This application is to
0 Demolition (interior
be used to apply for the following permits only (check ali that apply), O Air Conditioning
non-structural) 0 Electrical Alteration (not service change) Q Gas
❑ Heating Unit ❑ La
Lighter ❑ Gas Log
n Sprinkler 0 Mobile Home replacement ❑ Roofing 0 Sewer Line 0 Photo -voltaic
0 Ventilation ❑ Water
manufacturer).
Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
Complete all applica
le informa/tion on a application. Incomplete applications will not be accepted.
Application #V
For
/t
lU (U Date 1 !
office
use only
Job Site Address (re
y
tared} Value of Construction (labor, materials, profit)
i
d
p Q• � ega
Property Owner Name
Address City/State, . Zip. Phone
/F
A p11 t Name
Address City/Sfate Zip Phone
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Y✓ a-
�10 IL
Contractor
Address City/State ZiP` hone
Con (tor City of Ft. Cc
ilins Sal ax #
Saes laxnumberisrequirPd
yaYcvnbacwrs Are you paying with your trust account? Yes ❑ No
Is this a residential or cor
imercial project? Residential ❑ Commercial
If residential, is it: O E
Ingle Family Detach ❑ Condo/townhome (single family attached) : ❑ Duplex
EJ
ultlfamily (apartment) ❑ Garage
If commercial, !sit: ❑ 13
nk ❑ Bar ❑ Church ❑ Hotel/Motel O Medical office O ofi=ice O Retail
❑ R
ntaurant ❑ Other (explain)
is this building 50 years
age or more? ❑ Yes e'"O Ifyes, )vu may need to contactyistmic Preseruabbn
If this is for a demolition-
permit, what year Was the building constructed?
IfprYor to 1975, you MY r,
eed an asbestos assessment to submit with this app/fcaryon.
Descri tion of work
P 0 W
*If lawn sprinkler/baddlow
Dreventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors.- fi& fie
mpanyname or City of FtCcAiirsAnatse
Sectridan
Plumber rdechanlcal Roofer i Other
I hereby acknowledge that T
comply with all requirements
have read this application and state that the above Information is complete and correct. I agree to
contained herein and city ordinances and state laws regulating building construction.
permit is not valid until it
I know that a
has been paid and issued.
Applicant.
Print Nam
��rnv�tt - !r
v't. Signa
Date