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HomeMy WebLinkAbout1024 Oxford Ln - Applications/Reroof - 03/24/2015 (5)03-24-'15 16:20 FROM -Premier Roofing 9704848308 T-296 P0014/0016 F-591 -Fit L"wothns planning, pevetopment a Transportation 281 N, College Ave P.O. Box 560 Fort Collins, Co 80524 Phone 970-416-2740 Fax 224.6134 is OVER- THL-LOUNTER itPER M check all aITS ~�'� Air Conditioning This Demolition applicationY 0 Gas Lighter 13 Gas Log i:,3 Oemolitian (interior non-structural) GI t=lectrical Alteredoit (clot sere Ce change) 13 Heating Unit ❑ Lawn Sprinkler © Mobile Home replacement tCoflng U Sewer Line O Photo -voltaic 0 Ventilation CI Water Heater 0 Water Line O Wood/Pallet Stove (must be SPA certified, provide make, model and manufacturer). Complete all aPPlieabte Information on the application. Incomplete applications will not be accepted. Application # U 1 5 O G13^l . Dame .Rz^t Iaa 5 Fo/ fflw ueo only Job Site Address (required) value of Construction (labor, materials, profit) Property Owner Name Address City/State Zip Phone I�✓lf•l — �r / � y 7 0 � 22w y �l K 3` Applicant Name Address City/State Zip Phone Contractor Address City/state Zip Phone , CO" S 0"4 � 0 - y- u paying taxes here Contractor City of Pt, Collins Sales lax # Are yoor by report? Here 13 Wort Are you paying with your trust account? C] Yes C�No sohzvtarnumaer,armvkddbvdllconbaaorx Is this a residential or commercial prolect7 g Residential 13 Commercial if residential, is it: Single Family Detached 0 Condo/townhome (single family attached) C) Duplex )&Multifamily (apartment) 0 Garage If commercial, is it: 13 Bank 13 gar E3 Church C3 Hotel/Motel E3Medlcal office I3 Ottice 13 Retail C3 Restaurant O Other (explain) Is this building So years of age or more? d Yes XNo If yrs, you may need to contact Hlslarlc Preservation If this is for a demolition permit, what year was the building constructed? ifpriw• to 1975, you W111 need an asbestos asWssment to sdbmitWlth th/S appllcallon. Description of work *If lawn sprinkler/baddlow preventert must list licensed plumber. If first-time A/C, must list licensed electrician. . Subcontractors: lalstthe admpanyname orClty of FtColl/es Ilcenae # Plumber I Mechanical RWe other - Electrician. I hereby acknowledge that I have read this application and state that the above information is complete 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! a,�`y¢,,t _Signature Dpte 31zy 17A15 Print Name:,_ ^ .