HomeMy WebLinkAbout914 S COLLEGE AVE - APPLICATIONS - 9/21/201209-21-12;09:45 ;From:rtn roofing To:2246134 ;9705931119 # 1/ 2
C��e �n planning, Development & Transportation
�4tY�o�O��lr]S � I � I Vim" ' ` ��28i N. College'Ave P.O. Box 580
art ^�,, Fort Collins, CO 80524
/ 'V � 0 � rf V 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 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 ARocifing ❑ 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 # baw S`1145 Date
For office use only r Y �-i n , �i-,8
Job Site Address (requlred)
Value of Construction (labor, materials, profit)
I 5, eolle e_ AV-.
7e; -731/,0
Property Owner -Name J Address
City/State Zip Phone
Bes+wes�errt i(niv�e 11�� .. /`fS, ��'ll�;�-
r�.Colh s
Applicant Name Address
City/State Zip Phone
Seff 6-02oA 535 Loc*lzeAV<- 1,,Ov?.-6J U a0559 70-67-9raa
Contractor Address
City/State Zip Phone
R00f 'I�C 10C4 i0* 1CJ( /vtC , (I
« r( A
Contractor City of Ft Collins Sales Tax #
Are you paying taxes here or by report? X Here ❑ Report
Sam tax number ®wmdbyall mnbwtws
Are you paying with your trust account? ❑ Yes No
Is this a residential or commercial project? a Residential Commercial
If residential, is it ❑ Single Family Detached ❑ Condo ownhome (single family attached) - ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
if commercial, is it: ❑ Bank 0 Bar ❑ Church Hotel/Motel ❑ Medical office ❑ Office E3 Retail
❑ Restaurant . ❑ Other ( in)
Is this building 50 years of age or more? ❑ Yes CI No If yes, you may need to contact Historic Preservat/on
If this Is for a demolition permit, what year was the building constructed?
11°prlor to 1075, you M11 need an asbestos amassment to submit im&fi this application.
i of work _
ro •-t<A5 f
TZ Moil
0
*If lawn sprinlder/back low prevent&, must list licensed plumber. If first-time A/C, must list licensed elec6liian.
Subcontractors: List the company name or City of Ft Collins [/tense # a5 1 a
Electridan Plumber Mechanical Roofer —1 5 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 ordinancesand state laws regulating building construction. I know that a
permit is not valid until it has been paid and issued.
Applicant» K i5 rN q e y a G'"' - ----� - 0 / � //%
Print Name. l I'l Signature ate