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HomeMy WebLinkAbout321 Briarwood Rd - Applications/Reroof - 06/14/2019Waning, Development & Transportation City of 281 N. College Ave P.O. Box 580 Flirt Collins 1s Fort Collins, CO 80524 Phone 970-416-2740 Fax 224-6134 _47-WRI PERM. ITS ONLY hid at_,�ti? anon l4 10 t;e 3usw-d to, app for 'Ric fClEowing perrni1s c::Ey (check all that apply). El Air Conditioning li�?itlollei?r! ;!!relic;! n,,r-struc#urzl) !? Etis:ncaf Alteration (not Se►Vicp change) 0 Gas tighter 0 Gas leg 0 Heating Unit r1(evJn Sprinkler 0 tlobil_= Home re- lacemeni I0 Roofing ❑ Sewer tine 0 Pnoic-voltaic 11 ?f^ntilalior- ' i VVat' r.recter r1 ,A,'a4 bile D Wood/Pellet Steve (must be EPA certified, provide make, model and rgE>:psr*u �': aN�EleabEe 1:3`er€r!4rEL + e:: aE?a a�wErcaEl+�r.. Ene t nEera a°VDffra4inr s Will i2©Q Ana acCe�+EBL�. _D j�L/err i Izz f�zz..ve.zvz • vz ��LL4.--( r yr vrrmc ux v , i Job Site Address (required) � p Itse of Construciio r (IB' or, materials, profit) do sygrob Property Owner Name /jAddress d�ity/State Zip Phone Iti �®V V [�d✓r�Pi r �W / D D�� App!' t1t' Name Address deity/State Zip Phone �` %q6 Jai- � Contractor Address CIily/State/ ( Ziip� Phone y AA er Contractor City of Ft. Collins Sales Tax .N. Are you qaying taxes here or by report? jB.Here 0 Report S31a GWxnumberlsmgttredbyall mntracrors Are you aying with your trust account? 17 Yes K No ....................r.............................................................................................................................-._.............._......._.............................._..................................................... Is this a residential or commercial project?�1,411esidential ❑ Commercial If residential, is it: Cl Single Family Detached I:1 Condo/townhor�e (single family attached) ❑ Duplex fi Multifamily (apartment) 0 Garage If commercial, is it: 0 [lank 0 liar 0 Church 0 Hotel/Motel © Medical office 0 Office © Retail 0 Restaurant 0 Other (explain) Is this building 50 years of age or more? Q Yes O No If yes. ybu may need to contact Historic Piesen alion If this is for a denioliiion Permit; what year via:; tine building ronstri!cted? Pf pries• to 1974; you sill/l nced an asbestos assessment to submit itithi this application. I r &kllsprinkle!/backflow preventer, must list 11rer3sed plumber. If fii:st time A/C, must list licensed elecUician. Subcontractors: List the companyname orCity ofFt- Collins license # I Elcch ician Plumber __ _Mechanicalt _ I Roofer _� -!v , Other I hereby acknowledge that I have read this application and Mate that the'above information is complete and correct. I agree to comply wth,ali requirements contained herein and rity ordinances and state laws regulating building construction. 'a leriow that a perunit is not valid until iI has been paid arid. is5! ad. j print Hame:1�G._ ! Ae—lt-._ Signature �.dBate ot-I