HomeMy WebLinkAbout109 Yale Ave - Applications/Reroof - 05/14/2015City
or
IColtinS
Planning, Development & Tramp
281 N. College Ave P.O. Box 580
fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). ❑ Air Cond
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not se oe change) ❑ Gas Lighter ❑ Gas Lc
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement l�Rofing '13 Sewer Line ❑ Photo-volta
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, n
manufacturer),.
Complete all applicable information on the application. Incomplete applications will not'be accepted.
Application // 0 f'i Date
Sob Site Address (requireV
Value of Construction (labor, materials, p
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Property Owner Name
Address
city/stateTip Pho
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Applicant Nai6e
Address
City/State Zip Pho
Contractor
Address
City/State 2i
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Contractor of Ft. Collins
City
Tax # ii 0-5t
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Are you paying taxes here by report?
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Sa/estaxntanberisiequiredbyal/cor�advrs
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Are you paying with your trust ac=nl ❑Yes
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Is this a residential or protect? EQ:Nidential ❑ Commercial
If residential, is it Single Family Detached ❑ Condo/bownhome (single family.attached) ❑ Duplex
❑ Multifamily (aparbnent) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 59 years of age or more? ❑ Yes ❑ No _ If yes, you mayneed to confact Historic Pfassvabba
If this is for a demolition permit, what year was the building constructed?
Ifpnbr to 1975, you W11 need an asbestos amewient to submit wi1/i M& apprcation.
Description of work
*If lawn sprinkler/badcflow preventer, must'list licensed plumber. If first-time A/C, must fist licensed elattiaanT
Subcontractors: List Me company name or Gty of Ft Collins /iw/w #
oediidan Plumber Mechanical Roofer Other
I hereby admowiedge that I have read this application and state that the above information is complete and correct I
Comply with all requirements contained herein and city ordinances and slate laws regulating building corisi action. I ki
permit is not valid until it has been paid and issued.
Applicant: Name:: _{,. l-C���. sgnahr
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