HomeMy WebLinkAbout820 Merganser Dr - Applications/Reroof - 04/22/2015 (2)r Nanning, Devellopment & Transportation�€ Elf e 281 N. College Ave P.O. Box. 580
L—� C®W11 Its Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER— Ft HE —COUNTER P ETS ONLY
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.
G
Application II_ _=% i% %� i�✓?) f/ (i"il
For olfCe use only
Incomplete applications will not be accepted.
Date Li Lz;2-64-
3ob Site Address (required)
Vallue of Construction (labor, materials, profit)
G!'T 4a/�IAK
,. '3U 3_ 4-( ,Z/GPIA.� 5 /�
/7 s
Property Owner Name
Address
City/State Zip
Phone
qq
joy,
GCJ�IIK I�Z �5 ��
Gz-47�1-3��55
Applicant Name
Address
City/State Zip
Phone
y 5
Contractor
Address
City/State Zip
Phone
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here ❑ Report
Sales Lax number is required by all contractors
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or commercial project? X' Residential ❑ Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
XMultifamily (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 Historic Preservation
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. 05P740l/2�—:-4Arl) / p�
7
��" r.•` <� c_-,,� 77 -ram �- << r ,r � #ni'l� 2 5�2�/
*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 &1 44W 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: �,�yiI _jf(�� Signature
-�'�
� Date z
ikz (5