HomeMy WebLinkAbout646 STOVER ST - APPLICATIONS - 8/12/2011Aug-12- 2011 9:16AM Bob B e h r e n d s Roofing
No•3188
pity of p
Pla,mjngr Deveilopment & Trans;pur'catioo
281 N. College Ave P,O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVIER-THEMC UNTER PERMITS ONLY
This application is to be usel.to apply for the following permits only (check all that apply). O Air Conditioning
d Demolition (interior non-stnatural) ❑ Electrical Alteration (not seance change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Spe der ❑ Mobile Home replacement 19 Roofing ❑ Sewer Line ❑ Photo -voltaic
0-Ventilation ❑ Water Heater 0 Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
complete all applicable infonriation on the application. Incomplete applications will not be accepted,
Application. # R ��q �n Date
kr 01mce c6z arfy
Job Site Address (requirad) Value of Construction (labor, materials, profit)
Property Owner Name
Address
City/State
Zip
Phone
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v-�`� �. rs .�.;a.�
`\ -s I u -ate
Applicant Name
Address
City/State
Zip
Phone
Contractor Lie #
Address
City/State
Zip
Phone
Contractor City of R. CollinA SIS
Tax #
Are you paying taxes here Wr
by report? Here
❑ Report
Sales tarnumberisrequired by&crnaaemrs
Are you paying with your trust account? O'Yes
❑ No
Is this a residential or commen lit project? Residential ❑ Commercial
If residential; Is It: ❑ Singleikmlly Detached ❑ Condo/townhome (single family attached) - ❑ Duplex
❑ Mutbiatj (apartment) Garage
If commercial,'is It, O Bank 11-ear ❑ Church ❑ Hotel/Motal ❑ Medical office ❑ Office ❑ Retail .
❑ Resiaurmt ❑ Other (explain)
Is this building. 50 years of ageor more? ❑ Yes ❑ No If*, you may need to contact hlstorle Preservation
if this is for a demolition persaft, what year was the building constructed?
If prior to 1975, you will need aaasbestos assessment td submrt w/th this application.
work l� o, <
*If lawn sprinkler/badkflow praverLer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Use the ccvnpavy narre or Gfy ofR Collins license s
Electrldan Plunitzr Mechanical Rcohr — 1 a, Other
I herein/ acknowledge that i mveyd this application and state that the above information is complete and correct. 1 agree to
oomph/with all requirements _ontined herein and &I ordinances and state laws regulating building construction. l ltacvr✓ that a
permit is nit vz id until it bas 3e_n Paiat and issued. .
•Anoiicant:
-._ Signatura��\CN, c ,, 1 '] �Vca....a 5 Date .31LA\L_