HomeMy WebLinkAbout4406 San Remo Cir - Applications/Reroof - 09/05/2014Sep 09 14 05:05p Chuck Perry
9703449010
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City, of
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Planning, Development & Tran
281 N. College Ave P.O. Box 580
Fort Collins, CO 805241
Phone 970-416-2740 , Fax 22461
OVER-THE-COUNTER PERMITS
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This application is to be used to apply for the following permits only (check all that apply). El Air Conditioning ut
❑ Demolition (interior non-structural) 13 Electrical Alteration (not service change) CJ Gas Lighter ❑ Gas Log
0 Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement E3 Roofing ❑ Sewer Line 13 Photo -voltaic
• Ventilation 0 Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturers.
Complate all appillcabla lnwrmauon on the appucation: incomplete applications wilt not be accepted. 151 A�
Date ���— � ! T
Application # 11'
For office use a*
]ob Site Address
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Value of Construction (laborrinaterialS, Profit)
irl6le, Un ��18955
Fppe�I�lob
rty Owner Name
Address
San Fes^ . v)
C.J
city/ate ZiP Phone
G/�� 77 � gal �J - 57 / 5
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Applicant Name
0aibe2 {:t^Y
Address
614nhWn fi.
City/State i Zip Phone Q70 —
iTA& 9#- o Ultiv I �k,.Ob 865Z 02-.'7
Contractor
&4 oMy4 LtC
Address
16go Acl n 5-.
City/State ; Zip Phone
Unif 218 #190 �':Qt Ca q70--843-0113
Contractor City of Ft Collins Sales
Tax #
Are you paying taxes here or by report? )Oere ❑ Report
-Was &rxrnffnberlsreeraaedbya#cor ado
Are you paying with your trust account? ❑ Yes >(No
Is this a residential oYmultifamilly
merr.al project? KResidential E3 Commercial
If residential, Is itngle Family Detached ❑ Condo/t D mhome (single family attached) E3Duplex
(apartment) ❑ Garage
If commercial, is It: ❑ Bank ❑ Bar 13 Church E3 Hotel/Motel O Medical office 13 Office ❑ Retail
Ca Restaurant 17 Other (explain)
Is this building 50 years of age or more? D Yes i'�' NO Ifm you mayneed la can&cttAshufcPresermatim
If this is for a demol"rtion permit, what year was the building constructed?
. fprfar to 1975, you PwIl nead an asbestos assessnterltto sAwe witfe tries appfiobron.
*If lawn spdWer/baddiow preventer, must list licensed plumber. If first-timelie
A/C, must list licensed electrician.
Subcontractors: W We cvoWny name Ar a& offt Cbl#ns license # li — A 3
Sectridan Plumber Mechanical RwW . W2—lam Other
I hereby admoWledge that have read this application and state that the above 10hrmation Is complete and correct I agree to
comply with all requirements contained herein and city ordinances and state laws regulating bu Ilding construction. I know that a
permit is not valid until it has been paid and issued. i
PrinkName: ✓l�U Signature t .(/�' p ��