HomeMy WebLinkAbout4213 FALL RIVER DR - APPLICATIONS - 8/4/2014Drury Bros Roofing Denver
3032748602 p.2
u
Fort Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524� 25 q S
Phone 970416-2740 Fax 22+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 sere ce change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ?Roofing ❑Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ WoodlPellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application #S q g Date `
For office use only
Sob Site Address (required)
1 //�y,Value of Co(/nstruction (labor, maLte�ria�ljs�,/profii�t)
/
f 09 g'y"-
Owner Na Address
City/State Zip Phone
AppI nt Name Address'
M'145 L'." 3(96
City/State Zip �116 Phone
' - 9n &) 36any "W
Co actor Address
City/State �0 Zip Phone
Cont-actor ty of Ft. Collins Sales ax #
tra
Ell-
Are you paying taxes here or by report? ere ❑Report
Saks tax ruwmberisrequlredbya#conlrada m
Are you paying with your trust account? ❑ Yes ELL
ID q�
Is this a residential or eom al project? sidential ❑ Commercial
If residential, is it Ell§ingle Family Detached ❑ Condo/tDwnhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church 0 Hotel/Motel ❑ Medical office ❑ Office 0 Retail
❑ Restaurant 0 other (explain)
Is this building so years of age or more? O Yes IFyes, yrw may need In gvJ t Hist Preseryaben
If this is for a demolition permit, what year was the building constructed?
If prior m 1975, you will creed an asbestos assessment to submit with this applicati=
of work
*If lawn sprinkler/badcflow prevenier, must list licensed plumber. If first-time AjC, must fist licensed electrician.
Subcontractors: Lab the company name or, CRy of Ft CoAks iicsnSe #
Eiechidan Plumber
Mechanical Roofer ahem
I hereby acknowledge that I have read this application and state that the above information is complete and correct I agree tD
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: Print r�rp
Name: ll��"'LLII
Date �(