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HomeMy WebLinkAbout630 Brewer Dr - Applications/Reroof - 08/01/2017e/ ) o+411 Fort Collins Planning, Development & 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 IA Roofing ❑ Sewer Line ❑ Photo -voltaic ❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and manufacturer). Complete all applicable information on the application. Incomplete applications will not be accepted. Application # \J��d��-� 1 Date For office use only Job Site Address (required) Value of Construction (labor, materials, profit) 00 � Y`evue, Ir !`St0© Property Owner Ijam Address Zip Phone ct es a n b a r bat" W Bre.1/U2r^ r F� . �0 �I n S CO go q 76 310 -g 1 f Applicant Name Address City/State Zip Phone MICHAEL. cSLA0 20 CwAfloose De &r'1ELQ . CO 7064 Contractor Address City/State Zip Phone E E RZ Gyiietcj, Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? [WHere ❑ Report Sales tax numberIsrepubedbyall contract=. �X1o53 Are you paying with your trust account? X Yes ❑ No 5Mf COLLA1146 l.ACQJS6 110-3 Is this a residential or commercial project? 19 Residential ❑ Commercial If residential, is it: lid 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 morel ❑ Yes W No If yes, you may need to contact Hisionc Preservation If this is for a demolition permit, what year was the building constructed? Ifpnor to 1975, you will need an asbestos assessment to submit wah this application. Of �ft *If lawn spnnkler/bacldiow preventer, must list licensed p nber. If first-time A/C, niist list licensed electnuan. Subcontractors: List the company name or City of Ft Colons license # Electrician Plumber Mechanical Roofer Other I hereby acknowledge that I have read this application and state that the above information is complete and correcL 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: V1_ - " ' Print Name: ►lq(ytr Q��1�' Signature Date i