HomeMy WebLinkAbout2404 Sheffield Cir E - Applications/Reroof - 10/06/2017Oct 06
17, 10:43a RMRG
9702241211
p.2
City of
Planning, Development &
Trans
ortation
ort Collins
281 N. College Ave P.O. B
x 580
Fort Collins, CO 80524
Phone 97(1-416-2740 Fax
24-613
OVER-THE-COUNTER
PERMITS ON
Y
This
application is to be
sed to apply for the following permits only (check all that app
). ❑ Ai
Conditioning
❑
mblition (interior non-
tructural) ❑ Electrical Alteration (not service change) ❑ Gas Lig
ter ❑
as Log
❑ Heating
Urit ❑ Lawn S
rinkler ❑ Mobile Home replacement Aloofing ❑Sewer Line
❑ Photo
-voltaic
❑ Ventilation
❑ Water He
ter ❑ Water Line ElWood/Peflet Stove (must be EPA certified, p
ovide rr
ake, model and
ma
ufacturer).
Complete
all applicable i
rimation on the ap lication. Incomplete applications will not
be accepted.
Ap
iication #
Uu;M Date 19 — 6.17
For olTice
only
Jail
Site Address (require
Value of Construction (la
r, materi
als, profit`
Property
Owner Name
Address City/State Zip
Phone Q70
Orti �'
�:qn � ��feio. C1Q > ��FIZo (tN
;k-m— 8t�
App
icant Name
i
Address City/State Zip
Phone
Contractaor
�C'
tic
.BUJ �1tZ�i r1
Address City/State Zip
Phone q-10
o
Fex-
L5`. S, 1-a n liy �\e �'� L Co 5'
Zy
Zz�-1ZC-)
Contractor
City of Ft. Collins
numbers
Sales Fax # Ll 1--t;n , Are you paying taxes here or by repo
? ❑. H
re
tax required byall
ntrtcvs Are you paying with your trust accoun
? �I Y
:ReportSales
s ❑
Is this
If residential,
If commercial,
a residential or commercial
is it: �Singl
Multi
is it: ❑ Bank
❑ Restatirant
project? 1;� Residential ❑ Commercial
Family Detached ❑ Condo/townhome (single family attached)
mily (apartment) ❑ Garage
❑ Bar 0 Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑
❑ Other (explain)
❑ Du'
Retail
Is this
If this
If priar
building 50 years of ai,
is for a demorition permit,
to: 1975, you will need
e or more? ❑ Yes P�No If yes, you may need to contact Histo
what year was the building constructed?
n asbestos assessment to submit with this applieat fon.
tion
P, zse
Des
ri tion of work
/� k0
A¢ z o �- p (,,�
LPG v
w
*If la
n si rinkler/baddloer,
A/C, must list licensed el
must list licensed plumber. If first-tinm,
rician.
Sub
ntractors: List thIcalmn
1e1
name or City of Ft Collins license r? 1'9t V ��`� Z � VD
lElectri
"an
r Mechanical Roofar
O
r
I hereby
acknowledge that I have
read this application and state that the above information is complete at
id correct.
I agree to
com
with all requirements contained
herein and city ordinances and state laws regulating building cons
ucdon.
know that a
permit
is not valid until it h
been paid and issued.
Appii
ntc
Print
ame: "' VC
Signature L� Date
1 75 1 ttiCJL.0(A1lr