HomeMy WebLinkAbout314 Peterson St - Applications/Reroof - 05/05/2017Fcity of Planning, Development, & Transportation Services
ort Collins Community Development & Neighborhood Services
281 North College Avenue
Fort Collins CO 80524 Main 970 416 2740 Fax 970 224 6134 I�
OVER-THE-COUNTER PERMITS ONLY
This application Is to be used to apply for the following permits only (cheek all that apply) 0 Aar Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not serves change) ❑ Gas Lighter ❑ Gas Lop
❑ Heating Unit 0 Lawn Sprinkler ❑ Mobile Home replacement OrPoolling 0 Sewer Una ❑ Photo-voftalc
❑ Ventilation 0 Water Heater 0 Water Line 0 Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer)
Complete all aplpll�icable Information on the application Incomplete applications will not be accepted
CN Application * gOZ42Z, a IN70 23S —S - 2v17
rorofficeruleor* .
]Ob Site Address (nipulred) Value of Construction (labor, materials, profit)
314 ctcr'soo S t /Y pot 00
Property Owner Name Address City/Stateb�Zip /Phone
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Applicant Na a Address City/State Zip Phone
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Contractor Address City/State Zip Phone
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Contractor City of Pt Colilns Ales Tax # Are you paying taxes here or by report? VHere ❑ Report
swesawwmbwisMATd�yy a0oaobafrs Are you paying with your trust account? 0 Yes Vf4o
�2 09 /R-Z61S
Is this a residential or commercial project? Residential 0 Commercial
If residential, Is It: 0 Single Family Detached O Condo/townhome (single family attached) 0 Duplm
0 Multifamlty (apartment) 0 Garage
If commercial, Is It 0 Bank 0 Bar 0 Church 0 Hotel/Motei O Medical office 0 Office O Retail vh
O Restaurant ❑ O (explain)
IS this building 50 years o/ age or more? UYesCINo IfM you neayneed m yLsiwi<gasarheD6rnE',",�7'
If this Is for a demolition penrft what year was the building constructed?
Dgscrfption I work W C or v r0 2 t Zj { f b a,. N° w s . a
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*If lawn sprinkler/buidlow prewYiter, must Ilst acensed plumber If first-time A/C mwg Ibt Ik>e&W a eftdden.
SubemblC6ors: L&bC a cnmpanyAww orC7ly ofRCal/I w hbwm 0 (DO
PIum6erMedhankal Roofer Other
I hereby admowledge 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 tlnat a
pemNt Is not vaBd until It has /bear paid and issued.
Print Name !C� / ' / l (� y Signature p /
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