HomeMy WebLinkAbout900 Burgundy Ct - Applications/Reroof - 08/06/2015From: valerie jensen
Fax: (970) 223-9501 To: City of Fort Collins- Pen Fax: +1 (970) 224-6134 Page 1 of 1 08/062015 2:23 PM ._
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y�, Planning, Developmertt d,'Trans
r..r�, 'i..�•G',"4�.a.�ri` 281 N. Coll a Rortation
eg Ave P.O. 8ux 580
Fort Collins, CO 805T.4
Phone 970-416-2740 Far 72e_c,ne
OVER—THE-COUNTER PERMITS ONLY
This appllcation is to be used to apply for the following permits onl
Y (check f7 Demolition (interior non-structural) q Electrical Alteration (not sorv1'ce Chang ) al❑tGat as Lighter ❑Air Gas Lo
❑ Hearing Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement lI Roofing ❑ sewer Lie ❑ Photo -voltaic
Conditioning
❑ nufa tuner fJ Water Heater ❑Water Line ❑Wood/Pellet SIOvA (must be EPA cw. tiffed, provide make, mdel and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # 2> 15o5 j q j �
Frx o//rce use orJy Date ) S
Ilob Site AddrasS iiiaqutred/ L6GU l3 j Value Of Construction (tabcr, ntoten� )
Property Owner Name ' j =� 4 J S
rucin' lel Address City/state
iJl,Ye�`l/jC) /r r� nZip Phone /�U —
ApplicantName Addt
Address _
CitytState Zip Phone�"r�.
Cont, actors`r [ r
Address
City/state Zip Phone
Contractor City of Ft. Collins Sales Tax # ! /
G�rrra...uwnhcrgrnp,;;pyyyrN�,,,,�,ri�,. Mo you Paying taxes here or by report? Wliere ❑ R`—
L. Are you paying with your trust account? ❑ Yesro
— T
Is this a residential or rgmmercial project? � If residential, is it: Single Family 'Detached Residential ❑ ComrnercWl
❑ Mul[ifamil y O Condo/lownhome (single family attached) ❑Duplex
If commercial, is it:q gang Cl garP p Church ❑ Hoto9Yotel ❑ Medical office ❑
❑ Restaurant ❑ Other (expl Office ❑Retail
in)
No
Is this building so years of age or more? ❑yes ,
If this 15 for a demolition permit, what year was the buildlry consttuctW? need to rantuc, Hrstorlcy-es�yatrnn
/fprior to 7975, you wi//need an asbestos asse5.5.m nt to su bunt with this aAp11Cabo
Descriprion of vvork l)lCYQ 5
�—
i
`If lawns rinkler t 1/1 1 Cf l t f' C c.k�) (` T P /backflow preventer, must list licensed plumber. If frrsc_ - --
Subcontractors: /.fist the r time A/C, must list licenseA electddan.
tmpanynarne or City of Ft Co//ins ricerue
d
ecir¢ian_
1 herehv
P.:rmbq,
� Marlianicel_. Roofer
-- _Other
comply with all requii ements contained hereinanand aty arlo state that the ordinants and state above �forrnadon is cam etc aril
Permit is net vaNd until it has lxeen regulating twuding construclinrn.ct. Il knows a
Paid and issued. that a
Applicant: .Ir e' `[ `l n
Print Name, j��- '` %t Il. lT�/ti
�� SI natu
9 .�