HomeMy WebLinkAbout600 MILLER DR - APPLICATIONS - 6/20/2013 (2)Jun 191301:48p
9705688448 p.1
Westers Roofing
City of (%> - 1 SS 5
Planning, Development &Transportation
281 N. College Ave P.O. Box 580
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
❑ 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. 7r
Application # &3C)20(0 [ Date
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Job Site Address (required)
Value of Construction (labor, materials, profit)
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Property Owner Name
Address
Cfty/Sta zip Phone
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Applicant Name
Address
/Stale Zip Phone
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Contractor
Address
City/State Zip Phone
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ContraQor City of Ft. Collins
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Are you paying taxes here or by report? ❑Here Q Report
Are you paying Wlth your trust account? Yes ❑ No
Sales raxrxmrtterisreq(rred by all
is this a residential or commercial project? 'A Residential ❑ Commercial ❑ Duplex
If residential, is it: AtSingle FamilyDetached 17 Condo/townhome (single familyattached) PI
❑ Multifamily (apartment) ❑ Garage
If commercial, is it ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ other (explain)
is this building So years of age or more? Q Yes A"o rFyes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
IFprior to 1975, you will need an asbestos assessment to submit With this applk-36an.
Description of work
*If lawn sprinkler/backnOw preventer, must fist licensed plumber. If first-time A/C, must listdic;&sed electrician -
Su bcontractors: List the company name or Crfy of Ft Collins license #
Electrician Plumber Mechanical Roofer Wer
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 ordinances and state laws regulati Iding construction. I know that a
permit is not valid until it has beenpaidand issued. ' �i
Applicati>w btlN to
Print Name: Signature