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HomeMy WebLinkAbout3441 Fieldstone Dr - Applications/Reroof - 10/24/201410-24-'14 13:51 FROM -Premier Roofing 9704848308 T-251 P0002/0004'F-501 Planning, Dsvalapmento rransparmuon city. of Fcr N. College Ave P.O. Box Fort Collins, Co gp524 Phone 970-416-7740 Fax 224.6134 OVER-THE-COUNTER PERMITS ONLY This application is to be used to apply for the following permits only (checkall That apply). 0 Air Conditioning 0 Demolition (interior non-structural) 0 Electrical Alteration (not service change) 13 Gas Lighter 0 Gas Log 0 Healing Unit 0 Lawn Sprinkler 0 Mobile Home replacement L3 Hoofing 0 sewer Line 0 Photo -voltaic 0 Ventilation 17 Water Heater 13 Water Line Q Wood/Pallat Stove (must be EPA oe:tifled, provide make, model and manufacturer). Complete all applicable information on the application. Incomplete applications will not be accepted. Application- E21� f nn f o o Forame use only Sob Site Address (r iAmO Property Owner NarK Address Applicant Name Add ss per, n To,rou�ni/ �b Contractor Address Contractor City of Ft. C(MRS Salas Tax # 57/es bwnumberIsmgLdkd byall mnbedmss Date Value of Construction (labor, materiels, profit) UU Ju City/state Zip Phone City/stage Zip Phone City/state zip Phone Sul -fie $ - 481)- Are you paying taxes here or by report? L�ere 0 Report Are you paying with your trust account? ❑ Yes E3 No Is this a residential or cognferdal project? Iesldential ©Commercial if residential, is it; Mingle Family Detached D Cando/townhome (single family attached) ❑ Duplex J3 Multifamily (apartment) 0 Garage If commerdal, Is It: 17 Bank 13 Bar 0 Church O Hote(/Motel 13 Medical offlce 0 Office 13 Retail 0 Restaurant 0 Other (explain), Is this building so years of age or more? 0 Yes o ifyes,, yourrrayneedte cootectHistorfcResenrmHon If this is for a demolition permit, what year was the building constructed? lfpn'ar to 1975, you will need an asbestos assessment bo submit w/Bi b►rls appl/ca0on. Of *If lawn spdnklar/baddtow preventoq must list licensed plumber. If first-time A/C, must list Ilmsed electrician. Subcontractors: List the cnmpanyname 47TalyofFtCOSS/lx#-w p Electridan� Plumber_._ Med+a^i�t—�— Roofer Other I hereby acknowledge that I have read this application and state that the above Information Is oxapbte and correct, I agree to comply with all requirements contalned herein and city ordinances and state laws regulating building epnstruftn. I know that a permit is not valid until it has been paid and issued. Applicant: ,1 _,. �-r -2. Print Name: l' TTI I i'1 �l . Signature-S i Date