HomeMy WebLinkAbout648 S COLLEGE AVE - APPLICATIONS - 5/21/2014City of
Fort Collins
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 KRoofing ❑ 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 # 5114 Day,{S
For office use only
Date May 21, 2014
Job Site Address (required)
Value of Construction (labor, materials, profit)
648 College Ave
$18,895.00
Property Owner Name Address
City/State Zip
- Phone
Noodles `& Company 520 Zang -St.
Broomfield' Co
720-226-7243
Applicant Name Address
City/State Zip
Phone
Contractor Address
City/State Zip
Phone
Darby Enterprises, Inc. 1801 W. Irvington PI
Denver Co 80223 (303)-598-6313
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
IX Here ❑ Report
sales tax number is required by all contractors
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or commercial project?. ❑ Residential ® Commercial
If residential, is it: ❑ 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
IX Restaurant ❑ Other (explain)
Is this building 50 years of age or more? 19 Yes ❑ No If yes, you mayneed to contacthistoric Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work Remove existing roof to wood deck. Install 1/4" of 'so taper with 1/4" dens deck over deck.
Mechanically attach 60-mil TPO membrane 0. i k ,Q o s<1t'Q I a 4
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license #
Electrician Plumber : Mechanical Roofer R- / $ / / 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 not valid until it has been paid and issued. -
Applicant: LarryWall y
Print Name: Signature — ;e --� pate May 21, 2014
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