HomeMy WebLinkAbout519 Goldeneye Dr - Applications/Reroof - 07/09/2015Jul. 8, 2015 2:02PM Four Star on the Hill No.1509 P. 3
F� rt of
Planning„ Development & Transportation
281 N. College Ave P.O. Box SBO
Fort Collins, CO 80524
Phone 970.416.2740 Fax 224.6134
OVER-THE-COUNTER PERMITS ONLY
This application Is to be used to apply for the following permits only (oheek all that apply). O Air Condilioning
D Demolition (Interior non-slruclural) 0 Ulecldcal Alteratlon (not service change) a Gas Lighter LJ Gas Log 00
❑ Healing Will O Lawn Sprinkler 0 Mobile Home replacement 1] Roofing ❑ Sewer Line ❑ Photo-voltalo
11 Venlilallon 0 Waler }sealer Q Water Line 13 WoodfPellel Stove (must be CPA Certified, provide make, model and
manufacturer).
Complete all applicable Information on the application, Incomplete applications will not be accepled.
.Application # 5-D `? IQ 5__" � Date eras Mk 7-9 - Is -
Po oNke use ealy
Job Site Address frequlred)
5 !9 GbId6n e-va hr,
Value of Construction (labor, materials, profit)
009-00
Property Owner Name Address
Cf P» f iS 3C1V
City/State Zip Phone
r 974-g6 2-yoS
Applicant Name Address
City/state Zip Phone
Contractor Address
City/State ZIP Phone
Contractor City of Ft. Collins Sales Tax #
Soles I",1omDerIsngolredbyop ronGaelols
Are you paying taxes here or by report? Q Here Cl Report
Are you paying with your trust account? O Yes t0 No
Is rthdor commercial project? W Residential D Commercial
Ifessarasidentlal
6E Single Family Detached O Condo/townhome (single family attached) d ;Duplex11 Multifamily (apartment) 0 Garage
if commercial, is it: C] Bank ❑ Bar 11 Church C] Hotel/Motel I7 Medical office 0 Office R ReCj Restaurant ❑ Other (explain)
Is this building SO years of age or more? UYes QNo !f yes, you mayneed to contactHlstodc Pfon
If this is for a demolition permit, what year was the building constructed?
!f Iprior to f97S, you will need an asbestos assessment to subm/t with this appl/callon,
of work
*If lawn sprinkler/back0ow preventer, must Ilst licensed plumber. if first-time A/c, must list ikensed electrlclan.
Subcontractors: ttst the Company name ercity of Ft eollhts 11ra lee 0
Electddao Plumber MeclmikaL Roofer R_ -9914 Other
I hereby acknowledge that 1 have read this application and state that the above information is complete end correct. I agree to
comply With all requirements contained herein and city ordlnanees and state laws regulating building construction. 1 know that a
permit Is not valid until It has been paid and issued.
Appllcanti -- / f
PrintName:,/ /lit. P(� Signature Date /�