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HomeMy WebLinkAbout2605 Orchard Pl - Applications/Reroof - 08/18/2016r.,i# of Planning, Development & Transportation F-� 281 N. College Ave P.O. Box 580 lirt Collins Fort Collins, CO 80524 .'' v� '+o ` 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 0 Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic 0 Veritilation ❑ Water Heater ❑ Water Line ❑ WoodfPellet Stove (must be EPA certified, provide make, model and manufa('turer). Complete all applicable information on the application. Incomplete applications will not be accepted. Application # 61 Q OLI �V Por office use only Date 1 Job Site (requlred) Value of Construction (labor, materials, profit) Address I� Property Owner Name , 1 Ad dress 1 City/State Zip Phone Applicant Narne Address City/State Zip Phone '• Contractor Address City/State Zip ' Phone _ M GPAFTS)),b �vt �cWL%ov a Ca_ Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑. Here ❑ Report 3 tza'ourr.6er,'srequired byall cbntraCtors Are you paying With your trust account? 5KYe5 ❑ No is this a residentai or commercial project? :Residential ❑ Commercial residential, is it: X Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex ❑ Multifamily (apartment) ❑ Garage j If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Mbtei ❑• Medical offim 13 Office ❑ Retail © Restaurant ❑ Other (explain) is this building 50 years of age or more? ❑ Yes V No If yes, yvu may need to contact HlstoncPresemhon If this is for a demolition permit, what year was the building•constructed? _ I`prior to X975, you will need an astrestos assessment in submit with th/s application. Descrlption of work T-U -v3ve !„ ! tci 1, ec Ngw 4- 14z) A. a .&1gzYJ I Toe. Wc,+t( jr{ ,o4 k. 5 G �4rc� *if lawn sprinkler/5ackfiow preventer, must list licensed plumber. If first-time A/C, must list licensed el&tritian. Subcontractors: fist the company name or Gty of Ft Collins license # Electrician Plumber Mechanical — _ Roofer Other 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: RA10", ZN'`i- � y� ���`J Signatu(re ImDate 9 -4-1 L 3619