HomeMy WebLinkAbout1148 SPANISH OAK CT - APPLICATIONS - 9/15/201109/16/2011 07:43 3039389642 BMROOFING PAGE 05/07
Cltj/ Of
Dort Collins
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planning, Development & Transportation.
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524 -
Phone 970-416-2740 Fax 2M-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
0 Demolition (interior non-structural) 17 Electrical Alteration (not servige change) ❑ Gas Lighter 0 GasLog
O Heating Unit ❑ Lawn Sprinkler• O Mobile Home replacement 0 Roofing ❑ Sewer Une 0 Photo -voltaic
C] Ventilation 0 Water Heater ❑ Watar 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 # - �'� 3_%c 2 Date _
Formm only -
Sob Site Address (required) Value of Construction (labor, materials, profit)
Property Owner Name Address
4A ?06 'S
,City/State Zip
CAS) Avy, �l �. s'bc')41
Phone
Applicant Name Address . cityyStat t Tip
IR t-M J �G-3s
Phone
Contractor 1,1 Uc # Address
0 City/State 06 Zip LL
Phone L(
Contractor City of Ft Collins Sales Tax #
Are you paying taxes here or by report? 0 Here Report
)r<ll
Sa11°s tairnranbs9rCsr2pu0redbyall cnirtra
Are you paying with your.trust account? [3 Yes
No
Is this a residential or commercial project? b(Resldentlal O Commercial
If residential, is lt: ❑ Single Family Detached q�Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
ff commercial, is it p Bank 13 Bar 13 Church ❑ Hotei/Motei ❑' Medical office ❑ Office O Retail
17 Restaurant 13 other (explain) _
Is this building 50 years of age or more? O Yes it )-es, you may loed to cbntact l ire Pre-selw'bbn
if this is for a demolition permit, what year was the building consgvtted?
.aprfor tb.1975, you W7/need an &tests amamentto submit wo this app%bon.
Description of work
lawn sprinkler/beckHow preventer, must list licensed plumber. If first=bm A/C, must list licensed electrician.
subcontractors: Llst the Company name or orofR Collins license
Mechanlral - Roofer other
I hereby acknowledge that I have read this sppiication and state that the above information is complete and correct i agree to
comply with all requirements contained herfin and city ordinances and state laws regulating building construction. I know that a
permit Is not valid unto it has been pai I and issued. n A ;I
Applicant:
Print Name;—`►rt''•`'� "'iJ�S si nature Date L S'
• B - e
a