HomeMy WebLinkAbout636 BLUE MOUNTAIN DR - APPLICATIONS - 8/7/2014To: Planning and Development & Transportat Page 5 of 5 2014-08-07 20:00:10 (GMT)
19706928189 From: David Perez
City Of Planning, Development.& Transportatlon
281 N. College Ave P.O. Box:58
F^p�#(�'�otti
S
` "�'Fort Collins, CO 80524
Phone 970-416-2740 Fax 2241134
OVER-THE-COUNTER PERMITS ONLY
This
application is to be used to apply for the following permits only (check all that apply).
11
❑ Demolition (interior non-structural) ❑ Electrical Alteration 'ce
Air Conditioning
(not Q change) q:Gas Lighter
❑ Heating,Unit ❑ Lawn Sprinkler n Mobile Horne replacement^Roofing ❑ Sewer Line ❑
i p.Gas Log
❑ Ventilation ❑.Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provil
manufacturer).
hoto-voltaic
a make, model and
Complete all applicable information on the application. Incomplete applications .will not be
iccepted.
Application #_ I`t�5��_ Date 8/7/2014
For office use only
Job Site Address (required) Value of Construction (labor,
li terials, profit)
636 Blue mountain DrFort Collins CO.80525 8000 �
�i
Property Owner Name Address City/State Zip
Phone
Roselles Reade & Chantelle 636 Blue mountain Dr Fort Collins CO 80525 97063179I
7
Applicant Name Address. city/State Zip
Phone
Glenn Rennar 5489 Gulfstar Ct Windsor, CO 80528 9703917935
Contractor Address City/State Zip
Phone
Excel 08Q.-528 35
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report?
Sales
ere ❑ Report
.
tar.nwn.bor&requirdbyaucono-daOrs. Are you paying with your trust account? [}]
yes ❑ No
00049405
I
Is this a residential orcommercial project? Residential [].Commercial
If residential, is .Single
it: Family Detached 13 Condo/townhome (single family attached) ❑
6uplex
❑ Multifamily (apartment) ❑ Garage
{
If oommercial,. is itr •❑ Bank ❑ Bar ❑ Church ❑ HotelfMotel ❑ Medical:office ❑ Office ❑ Ret
it
❑ Restaurant ❑ Other(ex la' ).
Is this building 50 years of age: or more? ❑ yes No If yes, you may need to contact 1Y15t0ric Pr
�va60n
If this is for demolition permit, what year was the building constructed?
ser
If prior to 1975, you will need an asbestos assessmentto submit with this application.
j
j
I
Description of work Reroof wrth a 50 ear GafelkSbinyile 20SQQncStoKy
rl
._
i
*lf dawn sprinkler/badd9ow preventer, must list lid ensed plumber. If first-time A/c, must list licensed electriciafl1.
Subcontractors: List the company name or City'of Ft Col/ins license 0 I
`
Electrician Plumber Mechanical Roofer' i
Other -
i
I hereby acknowledge that have read this application and state that the above infonnationds complete and
I.agree to
comply with gall requirements contained herein and city ordinances and. state laws regulating'building wnstructi
permit is not valid until it hasbeen paid and issued.
n, I know. that a.
Applicant:
Print Name: Glenn Rennar
Slgnatu ._ Date
�.
/