HomeMy WebLinkAbout2512 Pine Needle Ct - Applications/Reroof - 10/13/201410-15-'14 12:01 FROM -Premier Roofing 9704848308 T-240 P0001/0001 F-487
planning, Developmemc at rrannpurwumi
F6'Pi'CO�lins For N. College Ave P.O. Box580
-61
Vvl'i' ` 1 ' Fort Collins, Co 60524
Phone g70-4ifr2740 Fax 224•fii34
OVERwTH&COUNTER PERM11M ONLY
This application is to be used to apply for the following permits only (check all that apply).13 Air Conditioning
0 Demolition (Interior non-structural) 13 Electrical Alteration (not service change) 13 Gas lighter 0 Gas Log
0 Heating Una 0 Lem Sprinkler Ci Moblle Home replacement Q Roofing la Sewer Line 13 Photo -voltaic
0 Ventilation 0 Water Heater 13 Water Line t] Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applicationsmill not be accepted,
Application #_
Forotf/ce die oMy
Sob Site Address (required)
Date
CC)�
value of conwuctfon (labor, materials, profit) ' V
Property Owner Name Address City/State Zip phone
Applicant Name Address city/state Ap Phone
T6f4 n n a race �b
Contractor Address
Address Cl /State ZIP phone
,P.Vj'JV Rx)G r1 3Xhe. to. Sul 4e 8 U
Contractor City of Ft.. Co i s Sales Tax # e you paying taxes here or by report? 1811ere 0 Report
Sfaraxarunberisrtivv6edbyauconAwebt Are you paying with your trust account? Dyes ONO
Is this a residentaI ore1nale
rcial project'd esiden"al 13 Commercial
If residential, is it: Family Detached C] Condo/townhome (single family attached). 13 Duplex
D Multifamily (apartment) O Garage
If commercial, is it: 0 Bank V Bar 17 Church Q Hotel/Motel 0 Medical office Q Office Q Retail
p Restaurant 0 other (explain),
Is this building so years of age or more? 17 yes o Ifyes, you mayneedin cnntad Hktoi/cParvaNan .f
If this is for a demolition permit, what year was the building constructed?
YAMOrto J975, you will nead an asbestos aze mantW submit with thisVA011aift
Of
*If lawn sprinkler/back1lew preventer, must list licensed plumber. If first-time A/C, must list licensed electrician,
Subcontractors: UstMOcnmpanynameorOlyofftColllnsllasnseas'
ElecWclan Plumber, _ M%hanioaL Router Other
I hereby acknowledge that I have read this applka "and state that the above InformaUm Is complete and correct I agree to
comply with
h all requirements
uit has e
me contained
herein wd paid and icityordinances and state laws regulating balding construction. I know that a
peris
Applicant: l Signature Date ,O�4l! y'
Print Neme:� .
2