HomeMy WebLinkAbout1224 Twin Oak Ct - Applications/Reroof - 09/25/2014�w
City of
/0,rrt Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6.134
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 se ce change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement T�Rooting ❑ 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 wilt no be accepted.
Application # Date _9
For oA%e iw only
lob Site Address (fwulfeo
Value of Construction (labor, materials, profit)
ladlj co,�. G+- (: rc+
Co l l vtS - $O S' 5—
Property Owner Name
Address
City/State Zip Phone
�
C4 15�-c eq'5� cif/5 -4109
Applicant Name
Address
Gty/State Zip Phone
Contractor
Address
CIty/State Zi -777
c1-154
w. S- . r-1co os3(
Contractor City of R. Collins
Tax
Are you paying taxes here or by report? ❑ Report
.sasraxnumderIsmqWfedbyall wf&acr s
Are you paying with your trust account? ❑ No
Is this a residential QLm rcial project?�❑`Rasidential ❑ Commercial
If residential, is it: mgle 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 If yes, you may need to conbctH124mic Preservation
If this Is for a demoll0on permit, what year was the building constructed?
Ifprlor to 1975, you wl/l need an asbestos assarrent to submit wifh th/s applkabon.
Description of work
*If lawn sprinkler/baddlow preventer, must list licensed plumber. If first-time A/C, must list licensed elecWwn.
Subcontractors: Ust the company name or Gty of Ft Collins license #
Elecbidan Plumber Mechanical Roofer Other
I hereby adviowiedge that I have read this application and state that the above information is complete and correct I agree bD
comply with all requirements contained herein and city ordinances and slate laws regulating building cDrWxucUon. I brow that a
permit is not valid until It has been paid and Issued.
Applicant:k _ \ `-` Signature
Print Name: iX.3
Date 9 hs h v---