HomeMy WebLinkAbout4512 MCMURRAY AVE - APPLICATIONS - 6/28/2012Jun,28. 2012 10:01AM ADVANCED ROOFING
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Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER-PTHE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). IO Air Conditioning
O Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter Cl Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement 4Roofing ❑ Sewer Line 0 Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet S ve (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # 8 1 � O
fof oirrCe use only
Date _ _ _ 0lao , 'a
lob Site Address (required)
Value of Construction (labor, materials, profit)
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Property Owner Name Address
City/State Zip
Phone
Applicant Name Address
City/S to Zip
Phone
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Contractor Address
city/state Zip
Phone
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Contractor City of Ft. Collins Sales Tax #
Are you paying takes here or by report? ❑ Here ❑ Report
salestaxnumber isrequiredbyall mntractors
Are you paying with your trust account?
0 No
Is this a residential or commercial project? . Q Residential ACommercial
If residential, is it: 17 Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage `
If commercial, is it: ' ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel Medic I office ❑ Office ❑ Retail
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❑ Restaurant *49ther (explain) _
Is this building 50 years of age or more? E7 Yes No ,Ifyas, you may need to contact Historic preservation
If this is for a demolition permit, what year was th uiiding constructed?
Ifptror to X 975, you Y111 need aniasbestvs assessment �p subm/t iv th this apo ation. �(
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*If lawn sprinkler/backflow preventer, must list lic0sed plumber. If first-time A/C, must IVt licensed electrician.
Subcontractors: Lrst the company name or City of Ft Collins license # / S 6 , S"�
Electrician Plamber Mechantral 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:
Print Name: l ,14 /�f Signature Date �oZ
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