HomeMy WebLinkAbout613 S COLLEGE AVE - APPLICATIONS - 3/13/2013Mar.13. 2013 12:54PM Roof Works, LLC,
No.9008 F. 2
.Cityof
1 281 N. DevelopmentTransportation
College AveP.O.P O. Box 580
FQIt+L Collins 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 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 WRoofing ❑ 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.
121
Application # JJ (30 bg Date A�
. For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
C.0l3 S CewtaE Avt.
Property Owner Name Address
City/State Zip
Phone
G by IND f U-6
o
`j7o. 3.-77o
Applicant Name Address
Clty/State Zip
Phone .
290) Al G
(49 �a112 902*/
1447.2se7
Contractor Address
City/State Zip
Phone
F 1�30 r
/3v a � 807(
/$2�
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here ❑ Report
5ale5taxnumberisrequiredbya/!contractors
Are you paying with your trust account?
❑ Yes [Z No
S-D 104 o
Is this a residential or commercial project? ❑ Residential 13 Commercial
If residential, is it: O 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
9 Restaurant ❑ Other (explain)
Is this building 50 years of age or more? $f Yes ❑ No If yes, you may need to contact Historic PreYOtVatlon
If this is for a demolition permit, what year was the building constructed?
rfprlor to .075, you will need an asbestos assessment to submit vfith this application. W I �� IVo1 Y1
!/I670dR f'.tFhMNEy
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list,licensed electrician.
Subcontractors: List the company name or City of Ft Collins license ,#
Electrician
Plumber_
Mechanical Roofer Other
I hereby admowledge that I have read this application and state that the above Informatlon Is complete and correct. I agree to
comply with all requlrements 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: , ,}
Print Name:�Dal& rNl(Ut2i- Signature 1A A. Date I�