HomeMy WebLinkAbout4437 Starflower Dr - Applications/Reroof - 10/15/2014eCity. of Planning, Development & Transportation
281 N. ege Ave
F6r 1. Collins Fort Collins, CO 0524 P.O. 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) ❑ 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 on the application.
Application # Z 1 1__i f 00p g
For olilce use only
Incomplete applications will not be accepted.
Date �h)
Job Site Address (required Value of Constru n labor, materials, profit)
4- 37-Mr��duier Qg 7C $ I g'bs, C)6
Pro erty Owner Name Address
City/State
Zip
Phone
Mn 6 Turn a- `l'f37 Stir-(/ow-e r 1�C
305�6 3d3 �a5
Applicant Name Address
City/State
Zip
Phone
Contractor Uc # F�: l�j$3 Address
City/State
Zip
Phone CI- 0
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Contractor City of Ft. Collins Sales Tax # L4 � 3 (p
Are you paying taxes here or by report? ❑ Here
J4 Report
Sales tax number isrequired byall mno-acmrs
Are you paying with your trust account? $ Yes
❑ No
Is this a residential or Vinmercial project? Ytesidential ❑ Commercial
If residential, is it: Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No Ifyes, you mayneed to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If plior to 1975, you wlll need an asbestos assessment to submit with this application. Q i
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*If lawn sprinkler/backflow preventer, must list licensed plumber. If first -tame A/C, must list lLcensLq el4ctrician.
Subcontractors: List Mecompany name orotyofFtCollins license # Ln✓"'Urwk- Ci 9
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 construction. I know that a
permit is not valid until it haa/" Signature Dates been paid and issued.
Applicant
Print Name:Jt9•f'/ c--',% / �(✓ / /
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