HomeMy WebLinkAbout2525 Clearview Ave - Applications/Reroof - 03/27/2017City Of Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134 zik /OI a6-
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 ❑ 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 # 6 120h000 Date 3-27-2_o (7
For ofte use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
2-52-5 Ueary iet,)
Ave_ -
Property Owner Name
Address City/State Zip
Phone
Kai(a Devin -TiQ-
Z525 GlGanlieWAJe. For(- ColliV19 $05
7W-t01--016
Applicant Name
Address City/State Zip
Phone
Grepr,Point F2oorj
1030 1%6*n m0 Co 8D5v
70043 -5
Contractor
Address City/Sta a Zip
Phone
Green+o;nf- ROoFi
403o Bn�rfz�i AJe, Lv hv?onf Cb Sa5ol
77D-6,wy-55
Contractor City of Ft. Collins ales Tax # Are you paying to es here or by report? ❑ Here ❑ Report
Sales tax number Isrequircdbyall contracfom Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? I19 Residential ❑ Commercial
If residential, Is it: ® 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 SO years of age or more? ❑ Yes ®No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you wilt need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/badcFlow preventer, must list licen36d plumber. If first-tlmeA/C, must list licensed
Subcontractors: L& the company name or City of Ft Collins license #
Elecbidan Plumber Mechanical Roofer & - ZL45!1 Other
I hereby acknowledge that I have read this application and state that the above information is complete and correct. 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: I ' CGL/t� �J
Print Name:_ Lls0. ltr.d�(rt r ' ` Signature Wy Date 3'7-7-1 7