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HomeMy WebLinkAbout4436 WARBLER DR - APPLICATIONS - 10/29/201410-29-'14 10:07 FROM -Premier Roofing 9704848308 T-252 P0010/0011 F-502 City. planning, DaveiopmentaTranspor=on Y �� MI N. CallegeAve P.Q. 8oX 590 Qrt Col��ns Fort Collins, co 90524 Phone 970-416-1740 Fax 114.6134 OVER-THE-COUNTER PRRrdl S ONLY This application is to be used to apply for the following permits only (check ali that apply). 0 Air Cond►tloning 0 Demolition (Interior non-structural) El Electrical Alteration (not service change) GI Gas Lighter 0 Gas Log 0 Heating Unit 0 Lawn Sprinkler 0 Mobile Home replacement 0 Rooling 0 Sewer Line 0 Photo-voltalc 0 Ventilation 13 Water Heater A Water Line 13 Wood/Pellet Stove (must be EPA carMod, provide make, model and manufacturer). Complete all applicable information on the application. incomplete applications will not be accepted. Application # n I H I D o 1 3 _ Date Faolfcie use ont/ Job Site Address Amulmd) Value of Construction (labor, materlais, profit) L_l , Property Owner Name Address City/state Zip Phone - ^� Applicant Name Address City/State zip Phone pin 6,rarmll16 Contractor Address City/State zip Phone , rP,>' cx 'i� ► MWlbe Sure$ $y-=7ta[-B3 Contractor City of Ft. Oo ns Sales Tax # Are you paying taxes here or by report? Caere 13 Report 5�Ie8taXnumberls�gwYc�dbyallG�ntracio� Are you payirig with your bust actount7 0 Yes 0 No Is this a resldential or co erdal project? esidentlal 0 Commercial If residential, is it; Ingle Family Detached d Condo/townhome (single family attached) 0 Duplex 0 Multifamily (apartment) 13 Garage If commercial, Is it; E3 Bank 0 Bar 17 Church © Hotel/Motel ❑ Medical office 0 Office O Retail p Restaurant t7 other (explain) Is this building 50 years of age or more? 13 Yes o !i`yas you maYneed fe mntactHlsbilcPrarervat/on if this is far a demolition permit, what year was the building constructed? ' Ifp►lOr M I975, you wll/na�edan asbestos assessmevrtto 5ubm/tWith this apaliW&A Of lawn sprinkler/back8ow preventep must Ilst licensed plumber. If first-time A/C, must list licensed eWitiaa, Subcontractors.VOtbO gmpanynameorLi!IyofRolUnsdcwnW# Electridan_ plumber. Mechanlwl Roarer. Other. I hereby acknowledge that I have read, this app(lcation and state that the above Information is compieteand correct, l agree to comply with all requirements contained herein and city ordinances and state laws regulating IwVdngcorstruction. I know that a permit is not valid until it has been paid and issued. Applicant: �1 _,, Data ` —0 1 1 Print Name:_QZA I�(0 1 L.� signature