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Home My WebLink About4330 Goshawk Dr - Applications/Reroof - 05/20/2015FROM :kessler FAX NO. May.20 2015 09:59AM P1 t City of Zt3ifiifi N.Colleg�Vble�lNAIO� Box WOMENcart Collins Fort Collins, CO 80524 Phone 970.416-2740 Fax 224-6134 OVERwTHE-COUNTER PERMITS ONLY This application Is to be toad to apply for the following permits only (check all that apply):.0 Air Conditioning * Demolition (interior non-structural) 17 Electrical A[Oeradon (not service change) O Gas Lighter O Gw Log ❑ Heating Unit 0 Lawn Sprinkler ❑ Mobile Home replacement ARoofing ElSewer Line 17 Photo-vollaic - * Ventilation © Water Neater E3 Water Line 0 Wood/Pellet Stave (must be EPA certified, provide make, model and manufacturer). Complete all applicable Information on the application. Incomplatia applications will not be Accepted. Application C Date 51W�(5 FarOfite use o ily Sob Sibs Address (equired) value of Constrttetion 0abor, mate 01% Prof* q30 Goo �c w 2300 . Property Owner Name Address aty/ Zip phone -Vao C` 30 FC 052/ 21 '`Nto9 AppgwrdNimie Address CRY/Sit ZIP Phone Contractor Vaeoler Address , f city/state zip(4?0 Phone Contractor City of Ft. Collins Sales Tax * 767CP4990 Slrkstaxntmdierk regaNrd byaiP tU�rracruvs Are you paying with your trust a000urrt? )KYes 17 No Is this a residential or commercial project? P(Residentlat Q Commercial If residential, is ib JkSlngle Family Wmctjed Q Cotndo/tovtmhome (single family atmchad) 13 Duplix 13 Muitiremlly (apartment) 0 Garage V commercial, is it: 0 Bank ❑ Bar CI Church ❑ motel/motel © Medical office © Office i7 Retail O Restaurant U Other (explain) Is this building 50 Vem cif age or more? ❑ Yes A(No If yeS, yew mEy/l Eed ro Hlstaik Pr rvaDiOr! V this is for a demolition permit, what year was the building constructed? Iy'pHorin i975, y+ou w:V/naed air ttSbas'du' e�StR7Erlt tt7.sr/arlLit raitli �k'�aja►kationt of work *If prinWw/baWow preventer, must list Ilaerrsad plumber. VUrsh*M AIC, must Ust BMW electrician. srrbrorrtraebors: [ist the avnpanyname or aay ofR c�rsdaa�e # • taemt�n. w I oft _ other I hereby acknowledge that I have read this apportion and state thatt a above information Is complete and eorreM I agree to comply with all requirements contained herein and city ordinanoas and state laws regulating building eonstrudim. I know that a par red! is not valid wild it has been paid and Inued.