HomeMy WebLinkAbout2732 Moore Ln - Applications/Reroof - 09/08/2017Sep 08 1710 54a Wasters Roofing, Inc 000000000 p 2
G y of Planning, Development & Transportation
281 N. College Ave P 0. Box 580
6rt Collins Fort Collins, CO80524
Phone 970-416-Z740 Fax 224-6134
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OVER-THE-COUNTER PERMITS ONLY
This appl ibation is to he used to apply for the following permits only (check all that apply). ❑ Air Conditioning
❑ Der ipn (interior non-structural) ❑ Electrical Alteration (not se a change) El Gas Lighter ❑Gas Log
❑ Heahn, Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement coring ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pe!let Sto a (mus: be EPA certified, provide make, model and
manufacturer)
Complet 'all applicableinformationon the application Incomplete applications will not be accepted
Applicati !n # b llinI-0 S a (9D Date ( j
For office use only
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lob Site Wdress (required) �� Value of Construction �(,tabor, materials profit)J7`Co (6Yll IcJE]LY J
Property ner Name Address city/state Zip Phone
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Applicant Name Address Cly/State Zip Phone
n o�^` \Ale!; el 8513 S- Cfz 13 );4.ceII,v,s 8050?j 4av ln90 iSyS
Contractor Address City/state Zip Phone
1,�ies-�erls Roo9 n Sq>,,� ,r R-/ssS i i
Contractor, itity of Ft Collins Sales Tax # Are you paying taxes here or by repot? ❑ Here ❑ Report
sates tax v-;pbe-- required by all crnvaaws Are you paying with your trust accounts XYes Cl No
Is this a residential or commercial prolel:0 Z Residential ❑ Commercial
If residentili is it XSingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ MLklfamdy (apartment) ❑ Garage
F!��Vj`',
If commerlial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office El Office O Retail , Ci
❑ Restaurant ❑ Other (eyplain)
Is this bulk ing 50 years of age more❑Yes No yes, you tnayreed to contact Nrs:orc. Preservahoq
If this is fo 4 demolition permitt,, y what year was thea bbuddingg constructed?
if prior to 975, you wi/J need an asbestos assessmep• t to submlt ivith this app.4cabon.
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Descripti
nlofwork C 0ve. Sta, Sh.h
!ea w G e— 4
*If lawn sp
Irjkler/baciiflow preventer, must list licensed plumber If first-time A/C, must list Ilcenseo electrician
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Subcontral
rs: 1,st the company name or Crry of Ft Collins lAcense
Electric an
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i Plumber Medianicl Roofer ar
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i hereby ac knowledge that I have read this application and state that the above informat,on is complete and correct I agree to
comply wit all regcirements contained herein
and city ordinances and state laws regulating building construction I know that a
permit is Act valid until it has been paid and issued
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Applicant:[
Print Nam IrJW j S JgY'-4 C91 I
Signature