HomeMy WebLinkAbout1930 Connecticut Dr - Applications/Reroof - 06/03/2016This application is
❑ Demolition (interii
❑ Heating; Unit ❑ 1
❑ Ventilation ❑ We
manufacturer). -
complete; all applic
Planning, Development .&Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
THE -COUNTER PERMITS ONLY
be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ .Gas Log
wn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
r Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
information on the application. Incomplete applications will not be accepted.
Application # e � 6 0 2qcl y
For office use only
Date
Job Site Address (required)
Value of Construction (labor, materials, profit)
O' Co✓1neC, CL,-� b r Co IIi•\c, KC&)(z- 4 2( 000
Property, Owner Name
Address City/State Zfp Phone
1430
d hec-4Cd Dr �7 -
Applicant Name
Address City/State Zip Phone
Contractor
Address City/State Zip Phone
0. I
'
+� a^d F= 4;- . -
ContractorCity of Ft.; Collins Tax #
Are you paying taxes here or by report? �ier.e ❑ Report
Sales tax number is required by allconbactors.
Are you paying with your trust account? ❑ Yes
Is this a residential or com dal project? esid❑ entfai Commercial
If residential, is it: ' gle Family Detach ❑ Condo/townhome (single family attached) ❑ Duplex
0 Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
10 Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No Ifyes, you may need to contact Historic Preservation
If this is fora demolition permit, what year was the building constructed?
Ifprior to 1975, you 411 need an asbestos assessment to submit wdh ibis application.
Description of work :Q,PtQAJQa*CD hr,,
*If lawn sprinkler/"ow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: list the company name or Oty of Ft Collins license #
Electrician Plumber Mechanical Roofer ether
I hereby ao0owledge 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: , l n!
Print Nacre: Signature �j vim— '/ �'41 Date
is