HomeMy WebLinkAbout937 Vanderbilt Ct - Applications/Reroof - 12/03/2014Nov 21 1410:10a
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281 N. College Ave P,0. Box 580
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Fort Collins, CO 80524
Phone970-416-2740 Fax224-6139
OVER-THE-COUNTER PERMITS ONLY
This 2PPlicatic
Demollilon (i
n is to be used to apply for the following permits only (check all that apply), 0 Air Conditioning
terlor non-st-uctura.)
❑ Heating Jnit
❑ _.eotricai Alteration (not service thane-) ❑ Gas Lighter ❑ Gas Log
D Lawn Sprinkler
❑ `✓entilation
❑ Mobile Home replacement ❑ Rcofing ❑ Se-weriine ❑photo -voltaic
Water Heater ❑ Water Line ❑ WoodiPeilei Stove
manufacturer,.
(mj5t be EPA certified, provide make, model and
Complete all a0licable
information on :he application. incomplete applications will not be accepted. -31O'
Application ;
T� ) �_Z-1-1� 1 v2• iJ' �"r
_ Date
_
for e,fce use only -
-
Job Site Address
3-7Gh(yt�[+�
(req rreof J/ Value of Construction ,labor, mater,als Profit)
a Jr J �- 4 1100
Property Owne
Name Address City'stat: Zip Phone
11/ 416�7
Apa!icant Nam(Address
City5tate = Zip Phone
—------ — e. � 1 _S—�:� 0- 6 `! 0 -/
-ontractor
Address City/State Zipphone
—LN .
4C7D,11,
Contrator City
of Ftsa s Tax r
Sai s rax number
—
5 required by all roncractor<. Are you paying with your trust account? 214es ❑ No
�f 0�77
is this a resider
jal or commercial prcjert? Residential ❑ Commercial
if residental, is
it: 2f4ingle Family Detached 0 Condo/townhome (single family attached) ❑ Duplex
O Multifa7nily (apartment) ❑ Carage
if commercia', I
it: ❑ Bank 0 Bar 0 Church ❑ Hctel/Motel ❑ Medical office 1Z Office ❑ Retail
❑ Restaurant 0 Other (cxplalr)
is this building
0 years of age or :ncr•=? ❑ yes rPQhde Lr,ves, yoe. way need to contact Historic Pre5CMM an
]f This is for a demolition
permit, what year was the b: ildiny .o stru��eo?
Y prior to 1975
_
you K,& need an asGcstos assessment to subrrvt svirh this a plicatlon,
Descriptiin n
work-i—
Gn;0Ali
;'If lawn sprinkl
_
rjbac'kinow pr=_venter; r.:ust list licensed plumber. if first -tine A/C, must, list licensed electrician. S^J'
Subeontracto
: Ust the cornparty :a: ;e or city of Ft Co,jins license
i-leanaan
— P Umber Mlebanl c21 Roofer We
I nereby ackrm ledge that I have read this aoplica io^ and state that the above information. is complete and correct. I agree to
:omply with all Requirements contained herein ant uty ordinances and sate laws regulating building construction. I know that
i permit is not valid until it has been paid and issued.
l
APPlicak d L/
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Print Name: • 2��i� Sitinatu ate
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