HomeMy WebLinkAbout5930 Falling Water Dr - Applications/Reroof - 12/26/2017•_,
C ty, ofEort Collin
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O ER"YmTH& ®YP
This application is to be used to apply for the folloI%
❑ Demolition (interior non-structural) ❑ Electrical Alter
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Horne rel
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Woo
manufacturer).
Complete all applicable information on the applicat
71 0 W20 1
Application # 1
For fice use only
2 story
Planning, Development& Transportation using payroll
281 N. College Ave P.O. Box 580 employees
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134 1�
ITER PERMS ONLY
ling permits only (check all that apply). ❑ Air Conditioning
allon (not service change) ❑ Gas Lighter ❑ Gas Log
lacement ❑ Roofing ❑ Sewer Line ❑ Photo-voftaic
/PelletiStove (must be EPA certified, provide make, model and
applications will not be accepted
Date
Job Site Address (required) I
Value of Construction (labor, materials, profit)
513 O t7&Lutii,�, "IErLIDCI uE
`$ I I 6 I i
Property Owner Name Address I
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City/State Zip Phone 9 40 -
FT
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Applicant Name Address I
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City/State Zip Phone
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Contractor A d ess t
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City/� tate Zip Phone
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N 511D1 iWl►4WS $i O
EN Lmxww co 80110 _
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? IkHere❑ Report
Saks fty 00 imber(e lq 11Yalimnmacros Are yl�payingwith your trust account? ❑Yes `kNo
Y
Is this a residential or commercial project? I( Residential ❑ Commercial
If residential, is Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
543 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,--* Nb If yes, you may need to Contact Hlstodc pnsPryatjon
If ibis is for a demolition permit, what year ws the building constructed?
Ifpnor to 1975, you wi/I need an asbestos assessment to submit w/th this application.
Description of work K rncyvE 34 5&5, E_Y MLNI a_E� efr;=LAIS4 SKY U
2 -eA00V.-_U'1 �4�A5 c> � c Ct�Ptil,Lnt�, i�1,vn-not�i , t�i tcN (�
T(T�AL" �INISi}Ff) Pcx�t= = l L�AYFl12
*If lawn sprinkler/baddlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Ust the company name or Crty of Ft Collins license. p
Elecblclen Plumber Mechantcal Roofer 3+ 1 lD Other
I hereby acknowledge that I have read this application and
comply with all requirements contained herein and city ordl
permit Is not valid until it has been paid and issued.
Applicant:
Print Name: M l t^,IC i KI ELSo►.
that the above information is complete and correct I agree to
s and state laws regulating building construction. I know that a
Date I 2 19 I I -:I-
119
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