HomeMy WebLinkAbout2539 Custer Dr - Applications/Reroof - 04/23/2015Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134 ¢I O5 ,��
This application is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ 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. Incomplete applications will not be accepted.
Application # 1J` f 02 fl 05 Date -3- 1 S
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
2 5;
Ca s7G5 25
Owner Name Address
Phone
Ciity/Sta)t/e•
.}P1ro�peer�ty
(� y/�
1%& LQ4� T ✓ats �s'l �lt �//' K, S
�f �Zip
�r I (r, L • i C C� 6 �S� S
Applicant Name Address
City/State Zip Phone
Contractor Address
City/State i Zip Phone
h.G"ca,r!; )Z316 t011, S,e,,, ' tovcLm....diCo eas37 ")7d-446-yy17
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here ❑ Report
Sales tax number is required by all contractors
Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? ❑ Residential ❑ Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
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 ❑ No If yes, you mayneed to contact HistoricPreseruation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work Rewt-a et G(�,sS 1( sC,;i, clue W, 92 ,S'4
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license
Electrician Plumber Mechanical Roofer 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 regulating building construction. I know that a
permit is not valid until it has been paid and issued.
Applicant:
Print Name: Sc�-A CL_ P710ev"ta-5 Signature
Date e-l—a3— (S