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HomeMy WebLinkAbout2608 Southfield Ct - Applications/Reroof - 10/29/2014City �COHIt15 Planning, Development &,Transpormldon 281 N. College Ave P.O. Box 580 Fort Collins, CO 80524 Phone 970-416-2740 Fax224-6134 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) ❑ Bectricai Alteration (not se "ce change) ❑ Gas Lighter ❑ Gas Log ❑ Heating Unit ❑ Lawn Sprinkler ❑ Motile Home replacement gLRoofing '❑ Sewer Line ❑ Photo -voltaic ❑ Ventilation ❑ Water Heater ❑ Water Line ❑ WoodlPeilet Stove (must be EPA certified, provide make, model and manufacturer).. Complete all applicable information on the application. Incomplete applications will not"be accepted. Application # ?7>1 Aj ()PS �_ Date For office rcm only Site Address (required value of Construction (labor, materials, Profit) Property Owner Name Address city/state I Zip Phone ado e 1=5-c Appiicant',Name Address City/State Zip ;Phone Contractor Address zl Ctty/State Zp 7777 C1-154 W a.� Co ts3% Contractor City of Ft Collins Tax # tl I ©'St Are you paying taxes here or by report? ❑ Here ❑, Report -We srarawnbe-smga �'edbyaYaw&acbm Are you paying with your trust account? O Yes ❑ No Is this a residential ormijaMptial project?/0 Residential ❑ Commercial If residential, is it ❑ ngle Family Detached ❑ Condo/towrihorne (single family attached) ❑ Duplex ❑ Multifamily (apartrr ent) ❑ Garage If commercial, is it ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Rail ❑ Restaurant ❑ Other (explain) Is this building S0 years of age or more? ❑ Yes ❑ No Ifyes, you mayneed to mnt3ctHistwicPrewx abbn If this is for a demolition permit, what year was the building constructed? Ifpnorto 1975, yav Wi7/needan asbestos assezmeat tosubmt with ffi sappllmbon. . *If lawn sprMler/bac131ow preverrer, must list licotmed plumber. If first -tyre A/G must list licensed electrician. Subcontractors. L&Mecompany nameorGtyofFtCaflinslicense d Beo= n Plumber hledmnkal Roofer Other I hereby acknowledge that I have read this application and slate that the above information is complete and correct r agree to comply with all rixorements contained herein and city ordinances and state laws regulating building construction. I know thal permit is not valid until it has been paid and issued. Applicant: PrintnTJ0 In