HomeMy WebLinkAbout951 Trading Post Rd - Applications/Reroof - 08/13/2018OVER-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
17 Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
d Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information
(orrmajtioonn on the application. Incomplete applicationswillnot/be accepted.
Application # 1 1 OU lJ l i-I Date
Forofllce use only
Job Site ss (requilad) �I Value of Construction (labor, materials, profit)
Property Owner Name Address City/State Zip , Phone
N1�r �L - I -Tracdl A 0 . ✓�
Applicant Name : Add(;[*SiateZip Phone
Contractor Address oty/state Zip y Phone
Lei- C -� CAS, tr7oc9C7-0030
Contractor City of Ft Collins Sales Tax # Are you paying taxes here or W report? -Kere ❑ Report
S71e9rax17umberIsnagrdredbyall ar aC=M Are you paying with your trust account? �{-Y2S ❑ No
is this a residential or commercial project? 6f6sldential ❑ Commercial
If residential, Is it �II Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartinent) ❑ Garage
If commercial, Is it ❑ Bank ❑ Bar ❑ Church ❑ HoteJ/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? Q Yes ❑ No tfyes, you may need to contactHismricP2serm on
If this is for a demolition pgrmlt, what year was the building constructed?
Description of work V4
*If lawn sprinkler/baddiow preventer, must list licensed plumber. If first -tome A/C, must list licensed electrician.
Subcontractors: List the company name orCRyofRCollins /lamse #
Elecbidan Plumber Mechanlwl Roofer Other
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I hereby aclmowledge that I have read this application and state that the above Informatlon 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 r
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Applicant: Q
Print Name: If - lo'17 —csc' SlgnaaW /L Dade O
neWsim date 2roaM7