HomeMy WebLinkAbout3556 PIKE CIR N - APPLICATIONS - 10/22/201410-22-'14 08:49 FROM -Premier Roofing 9704848308
City, of 2& N. College Ave P.o. enx 5du
®�' CO111175 Fort Collins, 00 90524
phone 970.416-2740 Fax 2244134
OVER-TH&COUNTER PERMITS ONLY
T-244 P0007/0012 F-491
This application is to be used to apply for the following permits only (check all that apply). 0 Air Conditioning
0 Demolition (Interior nonstructural) 0 Electrical Alteration (not service change) 11 we i-Ighter 0 Gas Log
0 Healing Unit 0 Lawn Sprinkler 0 Mobile Home replacement 0 Roofing D Sower Line p Photo•voltalo
0 Ventilation 13 Water Hestet 0 Water Line ❑ Wood/Pellet Stove (must be EPA candied, provide make, model and
manufacturer).
Complete all OPPI10able information on the application. Incomplete applicaticnswill not be accepted,
Application # bq I IOL4112 Rate
Fo iwffl pea only
Sob Site Address (rMIAN4r) Value of Construcdcn (labor, materials, protit�
L� , �' Ir, KI .
Property Owner Name Address City/State Ylp Phone
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- ,
Applicant Name Address City/State Zip Phone
�T�mn �rawr►ijlta
Contractor Address City/State Zip Phone
Contractor City of Ft.. Writs s Sales Taira # Are you ou paying with taxesaying here or byreport? ffrere 13 our trust account? A s 0 NReport
ales �rnymberisMOW bva//conLacm�s y
Is this a residential or cc ercial project? esidentlal (� Commercial
If realdenUal, is it: Ingle Family Detached 13 Condo/townhome (single family attached) C] Duplex
C) Multifamily (apartment) 17 Garage
If commercial, is it: 0 Bank 13 Bar 13 Church 0 HoteyMotel C3 Medical office 13 Office 0 Retail
0 Restaurant l7 Other (explain).
Is this building SO years of age or more? iD Yes Or lfya$ YOU may"Bd ib cnntad /l/star/c Prssenret/on
If this is for a demolition permit, what year was the building constructed?
Ifp#htto 1974 you #jnod an ashaslnx, asseMxent to submit w/th thlsappliratim
Of
*If lawn sprinkler/ba&RRow preventer, must list Ilcenwd plumber. If first-time A/C, must list licensed eladriclan.
Subcontractors-. ustbhe cnmpenynameordlyofRColllnsllcsrrsv &
Plumbar_____� MechanicalRoofer. Other
hereby acknowledge that I have read this applicatlon and state that the strove Information is complete and correct. t agree to
;omply with all requirements contained herein and city ordinances and state laws regulating building construction. I know that a
rermit is not valid until it has been paid and Issued-
Ipplicant: �_signature ��'�' "' Date 1 ,
Print Name: �-
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