HomeMy WebLinkAbout2718 Coal Bank Dr - Applications/Reroof - 03/26/2015Crty. ofPianrdn.% Developmen! IL Transportation
�JiL��nac! Fort Collins, 04 80524 P.O. 6 .1 580
Phone 974416-2740 Fax 22+6134
OVER-THE-COUNTER PERMITS ONLY
This applkhation Is to be used to apply for the following permits only (cheek.all that apply). O Air Conditioning
C3 Demolition (interior non-strructuran ❑ Electrical Alteration (not sentioe change) CI Gas Lighter ❑ Gas Log
M Heating Unit O Lawn Sprinider ❑ Mobile -Jame replacement, S Rooting D Sower Line d Photo voltaio
❑ Ventilation 17 Water Heater E3 Water Uno IJ WoodlPellet Stove (must be. EPA Certified, provide make, model and
manufacturer).
Complata all applicable Information an the epplloatlon. Incomplete applications will not be accepted.
Application # Dabe
rrwa fm am only
Job Site Address
Property Owner !Name
Name.
Contractor City of FL Collins Sales Tax #
aft rare nterirregrgtedbyre
Value of Constrn lion (labor, materials, profit)
• a 4ao.o�
Address CRy/State Zip 9CS2S Phone T70
Address
city/state ZIP . Phone
3 S ;B:--/ow
CitY/State ZIP . Phone
Are You Patnn9 tfts.here or by report?XHere CI Report:
Are You Paying with your trust accourv)C es d No
Wo.ev%vve 4 A —1S+
is this a residential or commercial prgj d? iI! Residential 0 Commewal
If residential, Is it: as Single Famny Detached ❑ Condoltownhome (single family attached) ❑ Duplex
0 Multrfamlly (apa*nant) 17 Garage .
If oommerdal, is it: i] 13ank Mar ❑ Church 4 HuWMotel 0 Medk'al office D office C7 Reall
.O Restaurant 0 Other (explain)
Is this building do years of age or more ayes a No .ifM ybu may rmw d m M1Ukt rim fun If this is for a demolition permit: what year was the [wilding constructed?
A`prlorm r973, ynu t-v6/need en a�estarsnerrt m submit rN1�i LhdsappllcaMprn. �,
Description of work —�
Ic
*If iawn sprinkier/ba�Mm preventor, must list kMmd plumper. If Brst-time A/C, must list licensed electrielan.
SuBcontmehx%9 LLst ape compawIM a ar ay of Pt Caw &MM 0
BPlhwn � Plumber MediaNraq� � 'other
1 hereby a*M[ ge {hatrPlIcation and stata that the above (rdbrrllatlon is complete and correct I agree to
cam* with a0 u rr�oo e a and sh tefaws regulating building construction. I know that a
permit layiet unSiYiEi1as been Bold tso v
ApBRaar�+f �s
Prtlgt Namq: SSI 111a4rro Date