HomeMy WebLinkAbout600 MILLER DR - APPLICATIONS - 6/20/2013Jun 19 13 01:48p Wasters Roofing 9705688448 p.2
PC SS S Planning, Development & Transportation
City of 281 N. College Ave P.O. Box 51310
Frt 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 ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
Cl Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information an the application. Incomplete applications will not be accepted.
Application #
I �JO'3 au-& Date " a° 13
For ofte use only
3ob Sibe Address ( uinad)
Value of Construction (labor, materials, profit)
Property Owner Name /I
/ Address
/s Zip Phone
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Applicant Name
Address
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Contractor
Address
City/State Zp Phone
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Contractor C ty of FL Collins
es,Toi #
Are you paying taxes here or by report? ❑ Here Q Report
53/es taxnumher �srequiredbyaii
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Are you paying with your trust account? Yes ❑ No
Kv'77
is this a residential or commercial project? o Residential ❑ Commercial
If residential, is it: 41-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 50 years of age or more? ❑ Yes .ANo If yes, you may need to conlact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos asq--�ent to submit with Uris application.
Description of work �` 4 # _
*If lawn sprinkler/badcflow preventer, must list licensed plumber. If first-time A/C, must list ' nsed electrician.
Subcontractors: List the company name or CO of R Col/ins rce750
Electrician Plumber Mechanical Roofer Other
I hereby acknowledge that I have read this application and state that the above information is complete and coned. I agree m
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.
apprlraM: 1, I. y1 UV�4 ' S Signa 're W 6
Print Name: ►t
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