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HomeMy WebLinkAbout636 Cheyenne Dr - Applications/Reroof - 06/30/2016 (11)Fort Conine Ciof Planning, Development 8r 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 Roofing ❑Sewer Line ❑ Photo -voltaic ❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet S ove (must be EPA certified, provide make, model and manufacturer). Complete all applicable information on the application. Incomplete applications will not be accepted. Application # IE�>l bo3-7a B. For office use only Date ez,302 1.6 303. ;?5 .lob Site Address (required) Value of Construction (labor, materials, profit) 36 nib Zz �3 7 Property Owner Name Address City/State Zip Phone �iar+ 117Y15 W C_64- %w lice 'e %�-ss ?�5a h?c��e/�AnG/ �✓ S)-e l criS � ` Applicant Name Address City/State Zip Phone Ci'7a) 2-82- — 26 'rt 69?6Co &-f- — 76 0 / Contractor Address City/State Zip Phone , c� �� c� //z a S-e &S�r��0-" 735.E Gr�nr7'Cl .e She C s ) Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? Here Report Sales tax number is required by all contractors. Are you paying with your trust account? ❑ Yes �NO Is this a residential or commercial project? K Residential ❑ Commercial If residential, is it: ❑ Single Family Detached Condo/townhome (single family attached) ❑ Duplex ❑ Multifamily (apartment) .❑ Garage . If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail ❑ Restaurant ❑ Other (explain) Is this building 50 years of age or more? ❑ Yes )W_No If yes, you may need to contact Historic Preservation If this is for a demolition permit, what year was the building constructed? If prior to 1975, you will need an asbestos assessment to submit with this application. Descri tion of work — wv c,,. cE,-,` •e ce w �� r— I. 'r rI a`, yr e_ri r) C i4 a cri" /-�L O,"rrr► cn *If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/c, must list licensed electrician Subcontractors: List the company name or City of Ft Col/ins license # Electrician Plumber Mechanical Roofer �D► in OJD 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 laws regulating building construction. I know that a permit is not valid until it has been paid and issued. Applicant: ., Print Name: %im (Jf Signat i � Date 3© s