HomeMy WebLinkAbout3274 Green Lake Dr - Applications/Reroof - 11/05/2018I
n Services
Fort
of Planning, Development, & Tian �I" rt CollinsosportatJ Community Development & Neighborhood lQ
Services
281 North C011ege
Fort Collins, CO 0524nua
i
Alain: 970.418.2740 Faz 9 .224.8134
OVER-THE-COUNTER PERMITS ONLY
I
This application is to a used to apply for �e following permits only
❑ Demolition (interior n n-structural) ❑ Electrical Alteratlon (not se c chan change) ala the apply). ❑ 1 G8s nditioning
❑ Heating Unit ❑ Lav{n Sprinkler ❑ Mobile Home replacement g) i Gas L ghter ❑ Ges Log
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, � ❑ Photo voltaic
manufacturer),I provide make, model and
Complete all applleable In ation on the a pllcation. Incomplete applications will not be accei bed.
Application # 1�5 CI f
for use only Date
]ob Site Address (rnq (lied)
Value of Construetlon (labor, materials, profit)
Property Owner Name I 3/`
Address CtY/State Zlp
6m l I Phone
970 2
� Applicant Name r' r
Address City/State Zip '
Phone
Ct1 O -
Contracror Address Ste• ZOI City/State S S
' - ZIP I I Phone
Contractor City of Ft. Collins Sales Tax # S*t Zo i Z l
� �,,,�,��rMukmd �o7ntrAre you paying taxes here or by rep rt? Mere ❑ Report
attc Are you paying with your trust aooD Int? ❑ Yes'
No
Is this a residential 11F"al project? ' idenbal E7 Commercial
If residential, is it: Single Family I Detached ❑ Condo/bownhome (single family atl
13 Multifamily
) 13 Garage
If commercial, Is It: ❑ Bank ❑ Bar ❑ Chutrch ❑ Hotel/Motel ❑ Medical office ❑
Is this building 50 yearsR� age or ❑ Other ( al'��n)
If this Is for a demolition e 9 ,More? ❑ Yes3 No If M yo4v �y n� to manta
rmit what year was the building constructed? i
Description of work tyP ,/ ro n /.
�n c'2. n.L nrni_
*If lawn sprinkler/baddlow I
Subcontractors: Z&jhecz
Bectridan
I hereby acknowledge Ithat
comply with all requirements
Perrtrlt Is not valid until it
Applicant:
Print Nam
fl Wrftdale2BQn17
nter, must list licensed plumber. If first-time A/C, must
ny name or Gty of Collins /ic&zw A
ba Mechanical_ RoofereA
read this application and slate that the above Infonnallo c
ained herein and city been paid and I ordinances and state laitls regubg it
Signature
❑ Du
Retail
correct. I agree to
tMn. I know that a