HomeMy WebLinkAbout5109 Fruited Plains Ln - Applications/Reroof - 03/31/2015City
of
�� Planning, Dev010131 gent & Transportation
ougns 281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
O'VL"#'Em(: JNTER PERMITS ®9®Ly
This application is to be used to apply for the followin Permits
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
y (check all that apply). ❑Air Conditioning
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement � Roofing ❑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.
Application Fo50 -j
r �
30b Site Addir//es��s'' (required)
S/ 0 % f—J'tiU' Ac- 1 �Gi i iL5
Property Owner Name
Applicant Na/me
Contractor
LOi'-)e
Address
SG b(�Ss O G G tic " 2
Address
Contractor City of Ft. Collins Sales Tax #
Sales taxnumberisrequired byall conbadom
Address
7355
Incomplete applications will not be accepted.
Date 2/:; /;`j_S
--------------
Value of Construction (labor, materials, profit)
City/State
513t-7 ZiP PhoneC-9-70)
f'� 6,3 - ci(,
-------------
City/State Zip Phone
city/state Zip Phone
rrr,—zz
Are you paying taxes here or by report? ,;'Here ❑ Report
Are you paying with your trust account? XYes No
Is this a residential or commercial project? esi�ential ❑Commercial
If residential, is it: Ingle Family Detached Condo/townhome (single family attached) ❑ Duplex
ff Multifamily (apartment) "C/Gaiage
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 J<No If yes, you may need to confactHistorfcpreseruatlon
If this is for a demolition perinitr what year was the building constructed?
Af prior to 1975, you will need an asbestos assessment to submit with this app/ication.
Description of work _fie—r'LcsF
t.-
0?0 . a5
*If lawn sprinlder/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontraftirs, List Me company name or City of Ft Collins licensed Toy- 0do P—OGfIYi�
Electrician Plumber Mechanical Roofer Imo— Other
—
I hereby admowledge 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 snow ghat a
permit is not valid until it has been paid and issued.
(Applicant,
Print giants: /ivy In �'n'i� signature
Cate