HomeMy WebLinkAbout809 E PITKIN ST - APPLICATIONS - 8/16/2013Aug 19 13 09:48a FM Roofing Inc.
1-970-221-8526 PA
Ci-ty,or-
�r� r 5 i - •_y
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 ARoofing ❑ 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 #% 3d 1 J U Date C� f I
CD
—+
For o1i%e use only
Job Sibe Address (required)
Value of Construction (labor, materials, profit)
Property Owner Name
Address
City/State Zip
Phone c/"%a
Zt t
AY\. N ?Oq
E LUI-CU'n H (0l t i1S (
�O 711 q 'W
Applicant Name
Address
City/State Zip
Phone
Contractor
Address
City/State Zip
Phone
A1 kob-i'i I
r s � n
/ L�
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
K Here ❑ Report
Sales tax number is required by al/ con.raetors
12 's 'i �
Are you paying with your trust account?
❑, Yes No
Is this a residential or commercial project? ((Residential ❑ Commercial
If residential, is it 0 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 ❑ No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Ifpnar to 1975, you iW1 need an asbestos assessment to submit with this ap#/icafion.
Description of work hP &%-0 Lq k t S Coo - "L f S% 1 t in P l
�a uhtLna+i'A CF-cam?n
*If lawn sprinkler/badcfiow preventer, must list licensed plumber. If first-time A/C� must list licensed electrician.
Subcontractors: List the company name or Qv of fit ColAns license 0
@ecbiaan Plumber Mechanical Roofer 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 ordinances and state laws regulating'building construction. I know that a
permit is riot valid until it has been paid and issued.
Applicant:
Print Name- Signature to