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HomeMy WebLinkAbout1001 Davidson Dr - Applications/Reroof - 11/07/2016�0fColtins Planning, Development & Transportation 281 N. College Ave P.O. Box 580 Fort Collins, CO 80524 Phone 970-416-2740 Fax 22+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 its change) ❑ Gas Lighter ❑ Gas Log p Heating Unit ❑Lawn Sprinkler ❑ Mobile Home replacement M Roofing ❑ Sewer Line ❑ Photo -voltaic ❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and" manufacturer). Complete all applioabift.info ation /on the application. Incomplete applications will not be accepted. App lication # 4O Date Forofiriie use onty lob Site Address (mqulmd) Value of Construction (labor, materials, profit) too - , s -Fc Ao--sa(- $ 3 966. o Property Owner Name Address City/State Zip Phone . tiv S l o Pc Co. o 5'u a 8(- •- 4 . o Applicant Name = Address City/State Zip Phone 0r401D PEAi,ecW-S-e-)' 2-32 S AA / L .v4` gga5 :a Contractor Lic # Address City/State ` Zip Phone GE04/A A, I or r.. tor Ao Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ® Here ❑ Report Sales rax number Is fwzffm d by all mntractnm Are you paying with your trust account? © Yes ❑ No Is this a residential or. commercial project? ❑ Residential ❑ Commercial If residential, is it:Single Family Detached ❑ Condo/townhome (single family attached) 0 Duplex a 19 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 ISNo ryes, you mayneed to contact HistoricPresen2don If this is for a demolition permit, what year was the building constructed? Yplior to 1975, you w/ll need an asbestos assaswnent to submit wiffi this appl/cafion. Description of work - i FA2 vF� 3 p VP L *If lawn sprinkler/backfiow preventer, must list licer sed plumber. If first-time A/C, must list licensed electrician. Subcontractors: Ust the company name or lily of At Corns license # GAP 2A Electrician Plumber Mechanical _ Roofer R.sclrlfi Other I hereby acknowledge that I have read this application and state that the above information is complete and cones. 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: a . / Print Name: D a WP f GA 7 AatA ' — Signature .� � Date / / < / / 6