HomeMy WebLinkAbout2756 County Fair Ln - Applications/Reroof - 04/03/2015artCollins
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28114. rn9• �eanent
at TransPo>tation
College Ave P.O. Box no
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
This application is to be used to apply �C®l11VrER PERMITS ONLY
13 Demolition (interior non-stru Pp Y for the followIn
❑ HeatingSprinkler 0 Electrical Alteration only (check all that a
Unit ❑ Lawn Sprinkler t7 Mobile Home repro a (no service change) pghte ❑Air Conditioning
� Ventilation � Water Heater g) 0 Gas Lighter ❑Gas Log
manufacturer). O Water Line ❑ W. A Roofing ❑ Sewer Line ❑ photo -voltaic
Complete all a lica61e ellet Stove (must be EPA certified, Provide make, model and
pp Information on the application In
APplication #
O
revise on/y
Job Site Address %4
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Al
Property Owner Name
complete applications *Ell not be accepted.
Date zil 3 /s
Value of Construction
0abor, materials, profit)
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Phone C--7?o
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Phone
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Phone
cv amiss
❑ Report
XNo
Is this a residential or commercial project?
If residential, is it: mgle Familyel ❑ Commercial
Detachedresidmit;
ndo/townhome sin le family attachedLI MUldfainily (apa�ent)rs e ( g ) ❑ Duplex
If commercial, is it: ❑Bank ❑Bar ❑ Ch ❑13 Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
Restaurant 13 Other (explain)
Is this building 50 years of age or more? . ❑ Yes fi(No Ifyes
If this is for a demolition pelmitr what year was the bullding con, struYouctedma?yneed to mnlactyis[or/c?reservation
Ifprfor to 1975, you wl//need an asbestos asse�eet 07 submit with tlatsa
,oP//cattvn.
Ar1/4!!Sf Mal.S�G�/f�j¢
Applicant Name
77, i i . ,
.S�.be u�cc-,G�r,
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Address
Contractor
r�// P�a� Address
Contractor 735,
Gty of Ft. Collins Sales Tax #
Sales taznumberts,rqulrad bya//cantradors
5',Gty/state
Cow
city/state
city/state
2 Sri d� p
FD,ti pLo/%�5
8aS'as-
Zip
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Zip
Are ou a ing ,V ,�a,x
Y P Y taxes here or by report? Okere
Are You paying with your trust account? Myer
u lawn sprract
Sider/baddtow Preventer, must list licensed plumber. If first-time A/C, must list licensed electrician. boontaactors: Ust&)ecompany name oralyoff"tC
off,
ns/iceirse#
Electrician Plumber
Mechanical Roofer S_ %his= 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 pennit Is not valid until it has been paid and issued, regulating building construction. Y know that a
Appli®nt.-
Print Name:_Ti.y-, >n Z, signature
Date , / S
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