HomeMy WebLinkAbout5503 Golden Willow Dr - Applications/Reroof - 11/10/201411/10/2014 16:22 3039352606 METRO PAGE 02/02
Fart Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO $0524
Phone 970-4115-2740 Fax 2246134
OVERmTNE-C DUNTER PERMITS ONLY
This application is to be used to apply for
❑ Demolition (interior non-structural) ❑ Elec:
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile
❑ Ventilation ❑ Water Heater ❑ Water Line
manufacturer).
Complete all applicable information on the
T; '4W 21
Application #
For office use only
Job Site Address (required)
5 i
Property Owner Name Addn
Ap licant Name Addn
r E4_
Contractor Ad r
1N
Contractor City of Ft. Collins Sales Tax #
Sales tax number is mqulred by all conbattcrs.
Is this a residential or commercial project?
If residential, Is it: Single Family Detached
Multlfamily (apartment)
If commercial, Is it: ❑. Bank ❑ Bar ❑ Churc
❑ Rpstmirant rl Other
Is this building 50 years of age or more? Q Y,I
if this is for a demolition permit, what year wi
If prior to 1975, you will need an asbestos asses
e following permits only (check all that apply). ❑ Air Conditioning
:al Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
ome replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
pplication. Incomplete applications will not be accepted.
E�+-
Date
Value of Construction (labor, materials, profit)
s City/State Zip
Phone
kvy Or VVI)i l' 1
3.1
s City/State Zip
Phone
.24 �-
City/State Zip
Phone
Are you paying taxes h re or by report?
❑ Here ❑ Report
Are you paying with your trust account?
❑ Yes ❑ No
sldential ❑ Commercial
❑ Condo/townhome (single family attached) ❑ Duplex
❑ Garage
❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
mplaln)
❑ No If yes, you may need to contact H/storlc Preservatlon
the building constructed?
rent to submit wilt th/s application.
D tion o work 0 _Tccty p���, �� IPY $� Yi° 17jg!'Q Lilrff
*If lawn sprinkler/backflow preventer, must list licei !d plumber. If first-time A/C, must list licensed electrician.
subcontractors: ust the company name or City of t Collins license #
Fiect ician Plumber Mechanical Roofer Other
I hereby acknowledae that I hava marl thic annii -.m: and data that the above information is LumpiCLC and Correa, i agree to
comply with all requirements contained herein and c i , ordinances and state laws regulating building construction. I know that a
Permit Is not valid until it has been paid and is i ied.
s
Applicant: 'C Date
Print Name: J Sigi iture