HomeMy WebLinkAbout1024 Oxford Ln - Applications/Reroof - 03/24/2015 (8)03-24-'15 16:17 FROM -Premier Roofing
9704848308 T-296 P0010/0016 F-591
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Fdrt Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, 00 80524
Phone 970-416-2740 Fax 224-6134
OVER-FTNEWCO- 1NTIER PERMITS ONLY
This application Is to be used to apply for the following permits only (check all that apply). 0 Air Conditioning
13 Demolition (Interior non-structural) 0 Electrical Alteration (not sera oe change) G Gas Lighter 13 Gas Log
0 Heating Unit CI Lawn Sprinkler O Mobile Home replacement 2ooiling c3 sewer Line 0 Photo -voltaic
Ventilation 0 Water Heater Cl Water Una 0 Wood/Pellet Stove (must be 5pA carlifled, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application _ A 1 1�5(21 q 01 • Date 31zMIR15
woxce uee dnlY
is this a residential or commercial project? V Residential t] Commercial
If residential, is It: Single Family Detached 13 Condo/townhome (single family attached) L3 Duplex
pMultiramily (apartment) 0 Garage
If commercial, is it: 0 Bank 0 Bar 0 Church 0 Hotel/Motel Q Medical office 0 Office 0 Retail
0 Restaurant 0 Other (expialn)
Is this building so years of age or more? Cl Yes %No ryes, you maynaed to tonfactHlstOHC Preservat/on
If this is for a demolition permit, what year was the building constructed?
Ypriorto mmis, you wl!lnee an asbestos assessment to submit with this aAP11catlon.
Description of work.
*If lawn sprinkler/badc8ow preventer, must list licensed plumber. If nr*Vme A/C, must list licensed electrician,
5ubcontracters: Llstthe companynamedrMY01rPtC"fisl/6ense #
electrician Plumber______L� Mechankal Roofer Other
I hereby acknowledge that I have read this application and state that the above information Iscomplete 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' �` "�," Date 7 12W
Print Name:, ,,phVe.,^ -Z signature