HomeMy WebLinkAbout635 Peterson St - Applications/Reroof - 04/26/2016APR-26-201611:58 From: To:9702246134 Page:1/1
City of
,- Collins
Planning, Development & Transportation
281 N. College Acre P,O, Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
`THr--UpUNTER PERMITS O
This application is to be u�d � applY for the followingONLY
❑ Demolition (interior non-structural) 4 Electrical Alteratio(not service ch
❑ Heating Unit 13'Lawn Sprinkler ❑ Mobile Home re Y (check all that apply)- p Air Conditioning
E3 Ventilation O Water Heater 0 Water Line b W� acement 04 change) a Gas Lighter q Gas Log
noting O Sewer Line O photo -voltaic
manufacturer), st Stove (must be EPA certified, provide make, model and
t~omplete all applicable Information on the application. Incomplete applications will not be acne
Applicadon # � 1 (0oaa oo ���
n/y Date
For aft& use a
Sob Site Addrew rrregvlreid,
(OsS bp�Sd,/t___j
Value of C�natruetion (labor, materials, profit)'
14 b o v
Property Owner Name
(�
Address
City/State j- �SC� ?,.�f
Phone
rr
ts (a ��
��ZIP
(' W
�'
Applicant Name
Address
t�l•
City/Mate
'Z�(W
Zip
Phone
Contractor Lic #'tZ2 i I'W
'
Address ?,2LO City/State ZIP
Phone
�r-�c�.r'
Contractor City of it. Collins Sales Tax #
_ UGI1
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u n����/ �J2.2r�
.t..�_ (1�1E'.S`�
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�`M 71
�+n�+�'is iulredbyallrontracaars
Are you paying taxes here or by report? tg Here
Are you paying with trust
❑ Report
g{1
your aocourit? O yes
No
Is this a residential or�' pnerdal project? 0 Residential ❑ Commercial
If residential, is it: IIf Single Family Detached ❑ Condo/townhome (single famil attach
0 Multifamily (apartment) O Garage y �) ❑Duplex
If commercial, Is It: ❑ Bank 17 Bar ❑ Church 0 motel/Motel IJ Medical office ❑ Office (3 Retail
13 Restaurant t7 Other (explain)
Is this building 50 Y"M pf age or more? 4 Yes M No IF
)am, X1l may need tt7 enntaet H/SLni7iC PmServ2h'ori If this is for a demolition permit, what year was the building constructed?
IfPlftrW 1975, yvv W/l need an asbes&V asmsmnent to submit with Mls applIcadon.
DemAption of work I,<e. c-o
*If lawn
If first-time A/C, must list licensed electrician.
Subeoniracbors: List me company name or City cifa Collins license # ' 6
Elechidanplumber Y J
',,, Mect>anica Roofer. Other
presenter, must list licensed
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 ordinano% and state laws regulating building construction. I know that a
permit Is not valld until It has been paid and issued.
Applicant
Print Name:fli-2_�� ��' Signature Data