HomeMy WebLinkAbout600 10TH ST - APPLICATIONS - 11/8/2011Nov 08 11 01:23p A J Shirk Roofing 19706695999 p.1
loer-mlv- -r our &0�z(ce
City o of !ct v)Gi Planning,m Development & Transportation
F®�¢ 41O 53 -� 281 N. College Ave P.O. Box 580
rt Collins s Fort Collins, OD 80524
Phone 970-416-274o 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 ce change) ❑ Gas Lighter 0 Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacementRoafing ❑ 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.
Application #.
For affix use only
Incomplete applications will not be accepted.
Date
lob Site Address (mgrmrd)
o /
Value of Con (labor, materials rofit)
67,5
Property Owner Name Address
I?lqr SFrdLre
city/State ZIP Phone
303 j?
s-7
or d W e110
Applicant Name Address
Gty/State Zip Phone ADO
Shirk j?oo-FlVr
Contractor Address
City/State Zip Phone
�ir coo-Ftn 8a5 E,
loST v Ltd o 80537 6l0q - 999
Contractor City of Ft. Collins Sales Tax * y1 O 3
Are you paying taxes here or by report? ❑ Here 9 Report
So/es awnundw&raweedbyaflmorrartars
Are you palling with your trot acmunt?,gYes D No
Is this a residential or W dal faoject? ential ❑ Comnrerdal
If residential, is it: Single Family Detached ❑ Condo/townhome (single family attached) ' O Duplex
❑ Multifamily (aparumnt) ❑ Garage
If commercial, is it ❑ Bank ❑ Bar O Church ❑ Hotel/Motel ❑ Medical office ❑ office ❑ Retail
❑ Restaurant p Other ( i )
Is this bwldng 50 years of age or more? Q Yes ,�plp If ya, you naay need tom7faa HisYom p1e�na&on
If this is for a demolition permit; what year was the building constructed?
Ifpnor to 1975, yew cavil/ needan ashes assiazment to sabrrclt *7M 6VS appt"bmn
of work
h
*If Lawn sprirdder/baciftm preventar, must list licensed plumber. If first-time A/C, mast list liemued electrician.
Subcontractors: list Ohe CwWny name or City offt Collins lichffcse 0 R /5FSf
Electrician dumber Medraniml
Roofer �_. other
I hereby acknowledge ledge that I have read lids application and state that the above irrforrnation is omptete and correct I agree to
comply with all requirements contained heeyn and city ordnance and state laws regulating building amstrumon. I know that a
permit is notvand until it has been paid and issued.
Appiknt. II / ,/•, -
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