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HomeMy WebLinkAbout748 Blue Mountain Dr - Applications/Reroof - 05/26/2015City Planning,, �eveiopmen;r.& Transportation olltn•� 2&1 N. College- Ave p.0, Fort Collins, CO••8O524 Box 58p Phone 910.4.16-2740 FU 224.6134 OVER-' 1"EmCOUNTER 1PERMI rr This..appliCAtion Ea to'be. used to apply for the following,perr;;,f onto rohaak an �`x 0 �emOliti0n (interior.non=struoturaq• Q Electrical Alteration, no 0 Heating Unit © Lawn: Cl i�Tobiie Home replacement service •chap a that dpply)•'O Air Conditioning. b Ventilation p 9) .O. Gas Lighter :0 Gaa Log manufacturer), Hater Heater ❑ Water Line .0 W ROQFn9 © Sewer. Line ❑ o0dlpe))et Stove Photo voltaic Complete all a (must k,e �pq Certified. provide make, model .ar1c p00able' information on the appiiaatlnn r Application .# for oflficr use only 70.5lite Address .(required) Ckrr� t�• I Property Owner Name. /7 c7 Address. Applicant Name c— :') n Address Contractor V r ,r, Address '1 F 1v,:7' q �� 9 ev Contractor City of Ft. Collins Sales Tex4 _ �?8x'nambc rsrequilvetya//conbacton, . N this nr�[`i'Ihw4i�l ticompfote applications wrtl not be acospted. Date Value of Construttipn. (labor, v� materials, profrt) �itv/State Zip Phone CiN/State zip / -Phone V city/state Zip / I 9 .Phone Are you paying. Ark you payintaxes here or, by report? Where 0 Report g with gout trU5t account? 0 yes Q, No -• • - •.-.,.�lruai ur commercial project? ZResidentai 0 Commercial T If residential, is, it: ii Single Family. Detached ❑:Condo/townhorhe•(sin0le.familyattached El: Multifamily (agar".. ent) El Garage, ) ❑Duplex If commercial, is it; ❑ Bank 0 Bar 0 Church- •E] Natet/Motel 0McGigl office II Office 0 Recall El Restaurant 0 Other (explain) Is this S for a e years of emit, more?• ❑Yes• No .Tfyes, you may need tn. rnntacr yisrnnc P�esen ahon If -this i$ for a demaiieion permit, what year was the building constructW? if pr/pr tp 1975, you will nod ap asfaestas Submit -W' ith th/s•epp/ication, • Description.+of work *If lawn sprinkler/baekRow preventer, must list Ncensea plumber. if first-time AIC, •must list licensed e!ectri:ia^. Subcontractors; Vst the companyname arCity of Ft 0011/ns license 9 Eleatrtdan Plumber_ _. 'MeCftan,cal Rt>OfOr t� Other I hereby acknowledge.that I rave read this application and state that., the above information is complete and correct. 10,gree to eornply with all requireMents; contained herein anA City ordinances:and:state laws,regulatirtg buildlrlg•ConsYruaron. z'knaw that a permit is clot valid until it has'peen paid and issued. Applicant; Print Name: )(. 1 'ate sionatu /zm/ Date