HomeMy WebLinkAbout1125 Stratborough Ln - Applications/Reroof - 09/12/2016City of 8 p PB-On np,1i1avdaprmne A Tranxpmulr>ron
281 N. Fort Collins, ege Ave P.O. Box 580
CO 90524
Phone 970-116-2740 Fax 22+6134
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(OVER-THE-COUNTER PERMITS ONLY
This ,application Is to be used to apply for the following permlte only/ (chach all that apply). ❑ Air Conditioning
EJ Demolition (interior non-structural) . ❑ Electrical Alteration (not service change) ❑ Gas Lighter O Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement A'Roofing O Sewer Line CI Photo -voltaic
C1 Ventilation ❑ Water Heater O Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable Informaltlon on the application. Incomplete applications will not be accepted.
APPlication # IWV515oS Date G 11Z1781(o
Fior ONCE use only r T — r
aob Es Addmw (required) Valu® of Construction (labor, materials, profit)
Z� t fit Ml(I z t 0-
Property Owner Name Address City/State Zip Phone
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Applicant Name Address City/State Zip... -Wc ne
Contractor Address City/State Zip Phone
Contractor City of Ft. Collins Sales Tam r Are you paying taxes here or by report? 13 Here ❑ Report
Swag tax InImaeruraquiiedtyall cmcraC S Are you paying with your trust account? 0 Yes O No
Is this a residential or mmercial project? c,Residential 13 Commercial
If residential, Is It: ,�Single Family Detached ❑ Condo/townhome (single family attached) ® Duplex
13 Multifamily (apartment) 17 Garage
If commercial, Is it: 13 Bank ® Bar 13 Church 13 Hotel/Motel 13 Medical office ❑ Office ❑ Retail
13 Restaurant ® Other (explain)
Is this building 30 ywrw of age or more? ❑ Yes ❑ No Afye s, you may n&V to contact H/storlc preservation
If this Is for a demolition permit, what year was the building constructed?
Afpr✓or to 1975, you will neadan asbestos asswment to subm/t W0 th/s application.
of work
*If lawn sprinider/bacMiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
-9ubC0ctMct®re: Ust the company name or City of Collins //case A'
Electrician 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 laws regulating building construction. I know Heat a
Psrfillt !s eicPt eella~ Until It hus beasra polrt and lure'.
Applicant:
Peist Wants: 11�C riV L � �('� Q �,�r:ateerL � prate