HomeMy WebLinkAbout7300 Silver Moon Ln - Applications/Reroof - 07/30/2019City,of Planning, Development & Transportation
281 N. College Ave P.O. Box 580
FlirC®ltins Fort Collins, Co 80524
Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following,permits only (check ail that 2pply).11 Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) 0 Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler O Mobile Home replacement AR 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 onn the application. Incomplete applications will not be accepted.
Application #_ I C-) S I(1 `� Date S
ror office no only ;mil �I i CCt GI
Job Site Address #equ/regi
Value of Constntetion (labor, materials, profit)
Property Owner Name Address Gty/State CD Zp po&. •�5 Phone
/ -,.--J � L --7 ?r7 n c
r / 76- c -
tpplicant Name . d t-k vl a Address GJ i i
S0Y C1ty/State Cv.1 o Zlp F05SSd Phon 0
Contractor Address
/State- Zip Phone
Broul
Contracor City of FL Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here- ❑ Report
Safes Oxnumbeitsrequiedbyalimn&sdom
Are you paying with your trust account? 10 Yes ❑ No
Is this a residential or commercial project? ,-Residential ❑ Commercial
If residential, is it: ��ingle Family Detached ❑ Condo/townhome (single famliy attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is It: ❑ Bank ❑ ear ❑ Church ❑ Hotel/Motel ❑ Medical office 13 Office ❑ Retail 7LD
❑ Restaurant ❑ Other (explaln) �—
Is this building 50 years of age or more? ❑ Yes _-No lfyes, you may need to contact HLsforic Preservadon
If this is for a demolition permit, what year was the{ building constructed? _ S
lfprior to 1975, you will need an asbestos assessment to submit with this appl/mt/on.
*If lavin springy /baddiow preventer, must list licensed plumber. If firs6drno A/C, must list licensed electrician: �Q p c,
Subcontractors: List the company name or0y ofR CoMns Boense #
Elecbldan Plumber Medtanical
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 mntalned herein and city ordinances and state laws regulating building construttlon. I know that a
permit is not valid until It has been paid and issued.
Print Name: ,'1-1 Signature —) i v - Date
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