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HomeMy WebLinkAbout2744 Pleasant Valley Rd - Applications/Reroof - 07/12/201607-12-'16 15:18 FROM -Premier Roofing 9704848308 T-512 P0003/0004 F-954 Cit of Planning, Development & Transportation Fart Collins Fort N. CollegeAve 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 ...--13J2emolition-(interior-non=structural)...❑. Electrical Alteration (not service change) •d7•Gas•Lighter•-❑-Gas•Log-- -- --- 17 Heating Unit ❑ Lawn Sprinkler l7 Mobile Home replacement X Roofing ❑ Sewer Line ❑ Photo -voltaic ❑ Ventilation ❑ Water Heater ❑ Water Line CI 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 # BAPI)3 q5 7 pate —1-:7 1*2 LO fhroffice use only Sob Site Address (twukvd) Value of Construction (labor, mater'ial�s,�profit) �2j A 4 PJ e=,ni 24 A., A � Q ( t Property Owner Name Address City/State zip Phone --n no ews Applicant Name I Address City/State Zip Phone L i k4 k I <'ALMf __-' - Contractor AddreU SWO J& City/State Zip Phone Co 0 t ulbeM Fbigplifos &J& 916-41:7—W5 Contractor City of Ft. CDdns Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report Mesbr"'b - . Are you paying with y0urtrust account? El Yes ❑.No reequiredbyallconndtois Is this a residential or commercial project? AResidential ❑ Commercial If residential, is it: "Single Family Detached O Condo/townhome (single family attached) 13 Duplex E3 Multifamily (apartment) d Garage If commercial, is it: 13 Bank U Bar 13 Church 13 Hotel/Motel Cl Medical office 11 Office © Retail 13 Restaurant 17 other (explain) Is this building so years of age or more? ❑ Yes JpNo If^ you mayneadfa avntacttfista cPreservvation If this is for a demolition permit, what year was the building constructed? Ifptlor io 1975, you w111 nand an asbasltas' assessment to submit with this applicalyoA of work *If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician, Subcontractors: Llstthe eompanynameorCityofftCE7///ns/itisns 4 Electrida Plumber Mechanical Roofer Other 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 ordinances and state Paws regulating buil4ing construction. I know that a permit is not valid until it has been paid and issued, 1 J Applicant: Signature be -7—1 Print Name: