HomeMy WebLinkAbout5114 Old Mill Rd - Applications/Reroof - 04/02/2015/rEb�. Planning, Developne.nt & Tra
0w onr®`lins 281 N. College Ave PO.Box58
Fort Collins, CO 80524
Phone 970-416 2740 F
®V��- 224-6134
Thy application is to be used to apply f �®LINTER t'ERMiTS ONLY
❑ Demolition (interior non-structural) for the followin
❑ Heating Unit ❑ ctural) ❑ Electrical 9 Permits only (check all that app►
awn Sprinkler ❑ Alteration (not service chap a y) ❑Air Conditioning
❑ Ventilation ❑ Mobile Home replacement g) Gas Lighter Gas Log
manufacturer).Water Heater ❑ Water Line ❑ Roofing
Roofing 11 Sewer Line
ellet Stove ❑ Photo•voltaic
Complete all a (must be EPA certified, Provide make, model and
applicable information on the application. Incom 1
Application # �1rh2-S�
&rO&C8 rise only —�
lob site Addr� (req�rj
Property Owner Name
Sl�bdcssociGsy�,�
QrYP.Sf
MPllcant Name
%:7. i i
Address
Contractor
Address
Contractor 73S
City of R. Collins Sales Tax #
Sales bxnunrderlsn3quliedtva//mnbacro/s
p ete appiications will not be accepted.
Datejs-
Value of Construction
pabor, materials, profit)
❑tY/State
5"31 P�5 Phone6q-7o
&3 - 5
City/State Zip
Phone
L9 >o� Codes •- ;
C1ty/State zip
Zu �. Phone
Are you Paying r �. • h/rd7dSo • CO e-0
Y P Y taxes here or by report? `Here p Report
you paying with your trust account? )@•yes NNo
Is this a residential or commercial projert?
If residential, is it: Single Family Detached ntial ❑ Commerdal
I� Multifami ndo/townhome (single family attached) ❑ Duplex
If commercial, is it: ❑Bank O Bar ❑ i� turd ❑ Garage
❑Medical office ❑Office ❑Retail
❑ Restaurant ❑ Other (explain)
Is this building 5o years of age or more? ❑ yes J<No ' fyes JVU mayneed to cnnbcrf H"& r/c pn—wenrddon
If this is for a demolition Permit, what Year was the building wristructed?
ffPr/or tb 1975, you rv///need an asbestos a a„t to wtmIt wlffi Ww aA0#tenon.
Descriptio'nJof work_,F w yrl,
*If fawn sprinlder/bacldjovv preventer, must fis71
t licensed plumber. If first-time A/c, must list licensed electrician.
Subeontradors: UstthecnmpanynameoratyofftCol/1ns/icae#
9ectridan Plumber
mmhanical_� Roofer-7—
oofer 7- T � Other
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 penult Is not valid unbl it has been Paid and issued, regulating building construction, I know that a
Print Name; Ti,•, �, /, „i� . Signature