HomeMy WebLinkAbout4306 WESTBROOKE CT - APPLICATIONS - 8/25/201408/27/2014 04:28 3032844067
city CA
O�'fi CollmS
RED DIAMOND ROOFING
PAGE 07/09
Planning, [tawelopment 8t Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524 13 , 2
Phone 970-416-2740 Pax 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) d Electrical Alteration (not sUlce change) 0 Gas Lighter ❑ Gas Log
D Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement )MRoofing ❑ Sewer Line EI Photo -voltaic
❑ Ventilation ❑ Water Heater 0 Water Line 0 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 #_021 H D770-7- Date
For ofte use only
Job Site Address (required)
Val- of Construction (labor, materials, profit)
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Property Owner Name Address
City/State Zip Phone
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Applicant Name Address
Gty/State Zip Phone
Contractor Address
City/State Zip Phone
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lben-, Vw SOW11 �A l05$ ~bap!
Contractor City of Ft. Collins SaIdTau
Are yoMaying taxes here or by report?)6 Here ❑ Report
trust O Yes No
Salestaxnu berisrequlredbyallmntmetom.
Are you paying with your account?
Is this a residential Ymmercial project? )(1 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 CI Medical office ❑ Office ❑ Retail
El Restaurant ❑ Other (explain)
Is this building 50 years of age or more? C3Yes 'P!LNo If yes, you may need in contact Historic Pmservatron
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 w/Nr this application;
Description of work
*If lawn sprinkier/backflow preventer, must list licensed plumber. If first -lime A/C, must list licensed eledrician.
Subcontractors: Ustthecompanyname orOtyofFtCOMM licens8R
Electrician Plumber Mechankal Roofer 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. re �1�0 �W�LV 6 2.91
Print Name: Signature date
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