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HomeMy WebLinkAbout4218 Mcmurry Ave - Applications/Reroof - 07/07/2015i City Development & Transportation F6City Of !! �j jj 281 N. College Ave P.O. Box 580 rt f�,�C has 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 (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 JX 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. Incomplete applications will not be accepted. Application # 431565133 Date For office use only —� J� Site AdalFessMiquiredn � Value of Construction (labor, materials, pr Frt) PS v�� ILJj o , ,S Property Owner Name Address �j riv �� �� C.o� X L 1©� e�� �e City/State Zip Phone Olrk) ce) a c, r �4 . c6 /li) 6 k-o 5 0 - 3� Applicant Name 1 �(1 r��(1Ct✓ Address City/State Phon e 'ip C]Z J�� \ ( 20 Z . �J Contractor Address City/State Zip Phone Contractor City of Ft. Collins Sales Tax # sales tax number isrequiredbyall contractors. Are you paying taxes here or by report? Here ❑ Report Are you paying with your trust account? ❑ Yes o Is this a residential c If residential, is it: If commercial, is it: Is this building 50 y If this is for a demo /f prior to 1975, you Description of wol *If lawn sprinkler/bac Subcontractors: Lis Immercial project? X1 Residential ❑ Commercial Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex Multifamily (apartment) ❑ Garage Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail Restaurant ❑ Other (explain) s of age or more? ❑ Yes , f No /fyes, you may need to contact Historic Preservation in permit, what year was the building constructed? need an asbestos assessment to submit with this application. Ue- a!�11'nl el,Sl,ln�5 ,_G�1d C(Cfe.SSCF^iCOS , VIA C! -r LLr wy c - 7ct r� 'I Y f✓Cc f- 1 �t- a r preventer, must list licensed plumber. If first-time A/C, must list licensed electrician. company name or City of Ft Collins license # Electrician Plumber Mechanical Roofer 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: //!� /j /� o Print Name: J " '� ; / `/ �/ In "� Signatureee/// Date i 3 / r