HomeMy WebLinkAbout4425 STONEY CREEK DR - APPLICATIONS - 7/30/2011Jul 3011 09:30a Atlas Roofing
9702661821 p.1
a of
oryt hits
Planning, Development & Transportation
281 N. College Ave P.O. Boot 580
Fort Collins, CO 80524
.Phone 970-416-2740 Fax 22+6134
OVER-THE-COUNTER PERMffS. ONLY
This application is to be used to apply for the following permits only (check all that apply). E3.Air Conditioning
D Demolition (interior non-structural) 0 Electrical Alteration (not service chainge) 0 Gas Ughter 0 Gas Log
D Heating Unit Q Lawn Sprinkler O Mobile Home replacement,*%ofmg O Sewer line D Photo -voltaic
0 Vent9lataon ❑ Water Heater 0 Water Une 0 Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applicationswill not be accepted,
Application* Date
Far vftZ.t� 0W
Job Sibs Address (required)
Value of Construction (labor, materials, profit)
425
Property Owner Name
Address
City/State -- Zip -
Phone
: FULtJ
Orze � �r 80�ZS �v2-L(01 _
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Applicant Name
Address
__
City/State Zp
Phone
ntractor
Address
City/State ' I Zip '
e
- r1
Contractor City of Ft Collins ScWts
Tax 11.
*�«t� O 38
Are u paying taxes here or report7911 Jere
yo p Y n9 Y
❑ Report_
Saks a:x nr nb6r rnquae bY0W convar&M
Are you paying with your try account?wA-Yes
0 No
)sluts a residential or commercial project? 0 Residential 0 Commercial
If residential, is it .0'S€ngle Family Detached Q Condo/townhome (single family attached) O Duplex
O Multifamily (apartment) l] Garage
If commercial, is it: CI Bank E3 Bar 0 Church O Hotel/Motel O _Medical office 0 Office O Reta-11
Restaurant 0 Other (explain)
Is this building 50 years of age or more? OYeszrko .If
Y�r !� mey need to mn�ct Kcsmra' Preserva�i
If this is for a demolition permit, what year was the building mnstrucbed? _
Kpr/or tD 197S,, you w1l/ need an asbertos assawnentto submit twtft thisapplicahiw.
of work
*Ir lawn sprinkler/taddlow, prevenW, must list licensed Plumber. If first-time A/C, must list licensed ern.
Subcontractors: list Me cariWny name or 01y ofFt C6/!os hbume 0
Uxtridan-- Plumber _ _ Hadeanical - Rooter - -- - Other
I hereby aclmowledge that I have read this appticat€on and state that the above information is complete and onre<t I agree to
comply with all regbirerrmft contained herein and city ordinances and state laws regulating building construction. I know that
permit is not valid until it has been paid and issued.
Appllcant:
Print Name: � _. _ _ Dane