HomeMy WebLinkAbout972 BITTERBRUSH LN - APPLICATIONS - 9/4/2014Sep 0414 08:19a Elite Roofing 3032433215 p.3
City, of
Fo�rt�, lt,
L. � Qac\-so-
Plaerdag, Developmaermt&Tmarmspn Cation
201 N. College Ave P.O. Banc 560
Fort Colfrns, 00 80524
Phone 970416-2740 Fax 224-6134 °s I ®®_ e�o
OVERmTHE-COUNTER PERM17B ONLY
This application is to he used to apply forth® following permits only (check all OW apply).13 Air Conditioning
❑ Demolition (interior noo-shuctural) O Elecbical Alteration (not ser3l& change) O Gas Lighter 0 Gas Log
O ideating Unit 17 Lawn Sprinlder Q Mobile Home replacement 0 Roofing 0 Sewer Line 0 Photo -voltaic.
Q Ventilation ❑ Water Beater ❑ Water Line O Wood/Peliet,Stave (must be EPA certified, provide make, model and
manufacduner�
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application #_ AD9h0S21s Date
Forafter eaWy
Job Sae A mess l squbeid^J
Yahm of consbuction (labor, mateial% profit)
Owner ame
�UCl
Addles
Qty/ zip,Phone I
i� (d�
Applicant Na4te
Address
7650'412hAwCo
City/State Tip phone
a
Contractor
"
Address it
city/stateTip Phone
-slat
Conbactor City of Ft. Collins es Tax #
Sa�50 51�rr�rhedbyaAmnaarmna
Are you paying taxes here or by report? WHere 0 Report
Are you paying vuith your trust account? ❑ Yes "o
Is this a residential or aomrervai project? arlZesidentiat ❑ Connnerrdal
If residential, is it: O'Single Family Detached ❑ Condo/Goumhome (single family attached) p Duplex
Li Multifamily (apartment) ❑ Garage
V oommerctal, is ID p Bank 0 Bar ❑ Church D Hotel/Motel Cl Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? I7 Yes t7 No If yer, you mayneedto contact fAstalkAesenrabnn
If this is for a demoliHoo permit; what year was the building aonsbuded?
Ifpnvrto 1975, yw *#/ need an asdestusassessinarttowbmitw& M&appkra8=
*If lawn sprinwindbadd low preventer, must list licensed plumber. if first-time Afc, must Im licensed amtridan.
Subcontractors., UstMe mmpmy name orOfyefRCokirrs fltertse 0
EkOidan Plumber. NeftffiML. Roofs, Other
I hereby ad=Medge that I have read this apprrcation and state that the above Wommation Is complete and correct I agree to
empty 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.
APpticamb
Print Name: &i1i1 .- ` S 1:W�nAr Slgm-ature