HomeMy WebLinkAbout4680 Player Dr - Applications/Reroof - 06/09/201508/05/2015 10:18AM FAX 3034200987 PROFESSIONAL ROOFING U0002/0009
City of
Fort Collins
OVER=
This application Is to be used to apply for the following pc
O Demolition (interior non-structural) ❑ Electrical Alteration (i
❑ Heating Unit CI Lawn Sprinkler 0 Mobile Home replacemi
L7 Ventilation Q Water Beater ❑ Water Line 0 Wood/Pellet
manufacturer).
Complete all applicable Information on the application. Im
Application # �J`)
raroam use only -
Job Site
Property Owner Name v Address
Name
Address
Contractor City, of rt. Collins sales'1•ai # Are you
Saes&Xwfti&rIsmqub AV#/lcaq&.vtrs, Are you
Is this a residential or 96merdal project? I'Residentlal . 17 Corn
If residential, is It. 13 Single Family Detached 13 Condo/townhon
❑ Multifamily (apartment) 0 Garage
If commercial, is It: Cl Hank 17 Bar 13 Church ❑ Notel/Motel p
C1 Restaurant O Other (explain,
Is this building 50 years of age or more? 4 Yes o[9A4 Ifyes, ya
If this Is for a demolition permit, what year was the building constru
ZfMor to 1-05, you rr///need an asbestas a&=sment w subm/t wish i
Planning, Development IN Transportation.
281 N. College Ave P.O. Box 580
Fort Collins, 00 80524
Phone 970-416-2740 Fax 224-6134
PERMIT ONLY
He only (check all that Apply). 0 Air Conditioning
service change) ❑ Gas Lighter 0 Gas Log
❑ Roofing O Sewer Line 13 Photo -voltaic
We (must be EPA certified, provide make, model and
Plot* applications will not be accepted
ate _ (� •'I, I
slue of Construction (labor, matsrlols, profit) �,�
V i/
Y/State Zip Phone
1 ^ 2f 1-- `7
Y/fro ZIP ,. 'Wane
r/State Zip Phone
ring taxes here or by report? M Here lie ort
ring with your trust account? 17 Yes
:relal
(single family attached)7Duplexedlcal olflce 0 Offlce
rraynead In m&ct H/stanc PmseWt/on
'*if lawn sprinkler/baGcFlow preventer, must list licensed plumber. If fl -tIr le A/C, must Ilst Ilcensed electrician.
5ubeontractpmrL&tMecumpanyname oratyofRCo///nslly& e,f
Electridan— Plumber Machanleal Other
I hereby acknowledge that I have read this appliration and state that the a ve Information Is complete and correct. 1 agree to
comply with all requirements contalned herein and city ordinances and state aws regulating building constructlon, I know that a
pormlt Is not valid until It has been paid and Issued.
Applicant -
Print RemaL Signature