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HomeMy WebLinkAbout4918 WILMINGTON DR - APPLICATIONS - 3/29/201203/29/2012 15:35 9705930124 GOLD ROOFING INC PAGE 01/01 kart COLlIns of Planning, Development & Transportation 281 N. College Ave P.O. Box 580 Fort Collins, CO 80524 Phone 970-416-2740 Fax 224-6134 OVER-THE-OUINTER PERMITS ONLY This application is to be used to apply for the following permits only (check all that apply). © Air Conditioning ❑ Demolition (interior non-strucwral) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log ❑ Heating Unit 17 Lawn Sprinkler ❑ Mobile Home replaoement XRoofing ❑ Sewer Line " O Photo -voltaic O Ventilation ❑ Water Heater ❑ Water line © Wood/Pellet Stove (must be EPA certiflled, provide make, model and manufacturer). Complete all applicable information on the application_ Application # Oil 0I1 91A For olilee use only Incomplete applications will not be accepted. •date 3- 29 -/Z Job � Address ,equlied> \ Value of Cam" Ct�ion (labor, materials, profit) . Property Owner Name Address city/stage Zip Phone r� GO /mil sk4' �91&GtJ%Im,Y� n + (_'a/l.hS LIO ADS Appl"cant Name Address City/State C Bau�t-- IyZY c,E�sehl d - (uV gfLd Zip 'P6 , Phone 9?-059 -3i;W Contractor Lic # Address City/State AmI oc. Zip Phone i2-/3t;-T Iy241 6: c;-24'fz av �- 8617 5�3-3680 Contractor City of Fe Collins Sales Tax # Are you paying taxes here or by report? ❑ Here . ❑ Report "at tarRumberis rawbadbya/lCW ac&rs: 3Z S9 ) Are you paying with your trust account? ;`Yes ❑ No Is this a residential or merdal project? Residential ❑ Commercial If residential, is it: ,� Single Family Detached ❑ Condo/townhome (single family attached) D Dupiexf ❑ Multifamily (apartment) ❑ Garage If commercial, is it: 0 Bank 13 Bar ❑ Church ❑ Hotal/Mobel ❑ Medical office ❑ Office 13 Retail E3 Restaurant ©Other (explain Is this building 50 years of age or more? O Yes �0 lfyes, y0umayneed tomntactHist3xi'cPia~setvatYon If this is for a demolition permit, what year was the building consbticted? Kprier to 1975, yw W11 nee an asbastvs azo rent to submit wlb4 ffis appllcab'an. h-�■�.�;.� .�r's�dG1l *If lawn sprinkler/backtiow prevenber, must fist licensed plumber. If first-time A/C, must list licensed elecbMan. SubcontracWrs: List the cvmpanyname or aty of Collins &wse f ter Medmical. Roofer 2--/3 Other I hereby aftowledge that I have read this application and state that the above information is complete and correct. I agree tD c'amply with all requirements contained herein and city ordinances and stake laws regulating butlmng mnstruchon. I larow that a Permit is not valid until it has been paid and issued. Applicaft Print Name.