HomeMy WebLinkAbout229 Annabel Ln - Applications/Reroof - 01/13/2015City of Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Collins
Fort Collins, CO 4
Phone 970-416-2740Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). 0 Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit 0 Lawn Sprinkler 0 Mobile Home replacement 0 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. Incomplete applications will not be accepted.
Application # Date
For office use only
3ab Site Address (rru.%rd) value of construction (labor, materials, profit)
2q , AAWAMI RAJ i $ 3 1 s sin
Property Owner Name Address
City/State Zip S
Phone
J-;(UOA El U10 2Z
I LA). J:7V-�Cdlirjs 165
9614_/0,f9
Applicant Name Address
City/State Zip
Phone
Contractor Li R Address
City/State Zip 79hone
vJ Rl»F
Contractor City of Ft Co ins Sales Tax #
Are you paying taxes here or by report? .0'Here
Q Report
Sales trxnumberisrequh-adbya//mn&actor_
Are you paying with your trust account? ❑ Yes
❑ No
Is this a residential or commercial project? KResidential ❑ Commercial
If residential, is it: qKSingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
Cl 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 I� No If yes, you may need to contact Historic preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 19751 you will need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/bacalow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Fc Collins Acense #
Electrician Plumber Medianical 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 has been paid and issued.
Applicant: J ` 9 � 133\ 1-1'�)-15
Print Name: �ilarr (Y�V A6 � — Si nature (. M, , Date