HomeMy WebLinkAbout602 AGATE CT - APPLICATIONS - 9/29/2011zf —�NQ220J 1 10:01 a Artisan Roof Repairs
970-223-9501 p.2
City Of Planning, Development & Transpolrta#son
Pe'► �q 281 N. College Ave P.O. Box 580
lau t CoRi s 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 (iirnerior non-structural} ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Healing Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement 0 Roofing ❑ Sewer line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater 0 Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application.
Application # F 110 �a39
Far oil use only
Incomplete applications will not be accepted.
Date
123. SS
Job Site Address (reqz'red) Value of Construction (labor, materials, profit)
Property Owner Name Address
_
city/Stag Zip
Phone
&!D-
ApplicantName f1v�'fv7 X� Address
City/State Zp
Phone C176)
I 33
—7cy
Contractor Lic # Address
GtY/State Zip
Phone
Contractor City of FL Collins Sales Tax fk
Are you paying traces here or by report? Here
❑ Report
sales tirnumt�is ar by
Are you paying with your trust account�Yes
❑ No
Is this a residential or commercial project? q1tesidential 0 Commercial
If residential, is it gle Family Detached ❑ Condo/o.wnhome'(single family attached)
MuMmily (apartment) 0 Garage
If commercial, is it ❑ Bank ❑ Bar 0 Church ❑ natal/Motel ❑ Medical office ❑ Oiii
❑ Duplex
ce 0 Retail
❑ Restaurant ❑ Other (explain)
Is this balding 50 years of age or more? O Yes o ifyes, you may nerd to 9X l HIMWfc p,S��
If this is for a demolition permit, what year was till building condructao
lfprror to 1975, you MY need an asbestos asp t to submit wr1Yr this applRabba.
Description of work
*If lawn spnnaa/backnow preventer, must ritst licensed plumber. If first-time A/c, must list licensed electrician.
Subcontractors: List bk- company name or City of Collins,6a7se #
Electrician Plumber Medkv&21 Roofer Other
i hereby adarowledge that i have read this appfxation and sl2ft that the above infomlation is oomph and commit I agree to
Comply with all requirernents contained herein and city ordinanoes and state taws regulating building constriction. I know that a
permit is not rabid until it has been paid and issued.
J
Applicant �' 11�
Print Name:_
Date��