HomeMy WebLinkAbout606 11th St - Applications/Reroof - 10/09/2015Planning, Development & Transportation
281 N. College Ave P.O. Box 580
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 1A.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 # b1507337 Date T� �0/�
For ofte use only
Sob Site Address (required) Value of Construction (labor, materials, profit)
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Property Owner Name
Address City/State Zip Phone
M R A/ X i of L
Poot:.r q l AZ ?son G0,4--• 991 -7Y5!
Applicant Name
Address City/State Zip Phone
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Contractor
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Address �� City/State ,p Zip '�_�c` Phone
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Contractor City of Ft.
s Sales Tax # Are you paying taxes hen: or by report? 0 Here ❑ Report
sales t" number is requfnrd by all carrbarmrs Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? i$Residential E] Commercial
If residential, is_ it: K Single Family Detached ❑ Condo/townhome (single family attached) E3 Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is M. ❑ Bank 13 fiat ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ other (explain)
Is this building 5o years of age or more? ❑ Yes iD No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
if prfor to 1975, you wit/ need an asbestos assessment to submit w/th this application.
Description of work fir. _Q,f SZ0%&bvG r ,cicrir 13liA IN,rAll `a_
*If lawn sprinkler/bacldiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name orG'ty of FtColllnslicense 0
Electrician Plumber Mechan"iml Roofer v Other
I hereby acknowledge that I have read this application and state that the above information S complete and correct I agree to
comply with all requirements contained herein and city ordinances and state laws regula-bril0 building construction. I know that a
permit is not valid until it has been paid and Issued.
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Applicant:
Print Name: G..-1 Signature Date
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