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HomeMy WebLinkAbout2424 Midpoint Dr - Applications/Reroof - 12/19/201412/19/2014 09:04 970-593-1119 of Fort Collins RTN ROOFING PAGE 01/03 Planning, Development & Transportation 281 N. College' Ave P.O. Box 580 Fort Collins, CO 80S24 Phone 970-416-2740 Fax 22+6134 OVER-THE-COUNTER PERMITS ONLY This application Is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning ❑ Demolition (interior non-structural) ❑ Eilectrical. Alteration (not service change) ❑ Gas Lighter ❑ Gas Log ❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement gRoofing ❑ Sewer Line • ❑ Photo-voitaic ❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/PeIW Stove (must'be EPA certified, provide make, model and manufacturer). Complete all applicable information on the application. Incomplete applications will not be accepted. Application # MI5_ ___ E57 Date /�2/l 9ll'f For ofte use only Sob Site Address (mqulred) Value of Construction (labor, materials, profit) a ya y M � �1 d l n -i- �r-', - �' �•��, 79�, oo Property Owner Name Address City/State Zip Phone WW. +' 11500, kobVardlez- l3/5 YJe.Inwa5�51e.10 �o��e✓ CO%.$1�30Z 30-L/�2�9s;8 Applicant Name Address city/State Zip Phone UeT Lo_ AVc j,,t7VeUa CD aD522f 7o-.25_Y/60 Contractor Address City/State- Zip Phone (J ©c�'I'Jt S�eYhS tt tt rc A Contractor City of Ft Collins Sales Tax # Are you paying taxes hen: or by report? ,1d Here © Report sales tarn bya�iaMtracrwx Are you paying with your trust account? ❑ Yes ;<No Is this a residential or commensal project? ❑ Residential ,Commercial If residential, is it: ❑ Single Family Detached 0 Condo/townhome (single family attached) ❑ Duplex ❑ Multifamily (apartment) ❑ Garage If commercial, Is W. ❑ Bank • ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ,.Office ❑ Retail 0-Restaurant : ❑ Other (explain) Is this building 80 yearsof age or more? O Yes ❑ No If yes, yvu may need to eoniactHistoric Preservation If this Is for a demolition permit, what year was the building constructed? Ifprior to 1975, Xv w#/•need an asbesms azagwment to submit with this application. Description of work fAA:4e r; a./. *If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed eiech'idan. Subcontractors; Gist the company name or pry of FtCo/Ilns l/cense f Elecbtdan Plumber Mechanical Roofer,2�16f 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: 2� Print Name: 9i'1 s�i`n fylal�'ICc✓l Signature Date /i 91( 7r`