HomeMy WebLinkAbout936 SAILORS REEF - APPLICATIONS - 6/11/201506-11-'15 11:38 FROM -Premier Roofing
Fart Collins
/110�
9704848308 T-336 P0002/0005 F-653
Planning, Development & Transportation
281 N. College Ave P.O. Box 560
Fort Collins, CO 80524
Phone 970-416.2740 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). 0 Air Conditioning
b Demolition (interior non-structural) ❑ Electrical Alteration (not service change) Cl Gas Lighter d Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement *Roofing ❑ Sewer Line L3 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. Incomplete applications will not be accepted.
Application # $1 15nAA?tn Date
ror ofte use only
Job Site Address (required)
Value of Construction (labor, matgrials, profit)
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Property Owner Name Address
City/State Zip Phone
1, . r 6 h r1son
-a R
A plicant Name Address
City/state Zip Phone
Contractor Address
City/State Zip Phoneg10
Contractor City of Ft. Collins4ales Tax #
A&4ou paying taxes here or by report? Here ❑ Report
Ss/ayWnumberIsreWredbya//cr lmdors
Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? 'I$Aesidential ❑ Commercial
If residential, is it: AfSingle Family Detached 0 Condo/townhome (single family attached) 0 Duplex
13 Multifamily (apartment) O Garage
If commercial, is It: [3 Bank 0 Bar ❑ Church 13 Hotel/Motel 13 Medical office O office Q Retail
0 Restaurant 0 Other (explain) _
Is this building 5o years of age or more? 13 Yes o if yes, you may need to contact Hlstanc Presarvaift
If this is for a demolition permit, what year was thb building constructed?
0prior to f975, you w111 need an asbestos axsessment to submit with th/s app/lcaton.
work
*If iawn sp4kier/back0ow preventer, must list licensed plumber. If first-time A/C, must list licensed electrdan,
Subcontractors. list the company name orG)ty of Pt COX')$ Ace,759 #
Eieciridan. Plumber. Mechanical_ Hoofer Outer
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 Namej hi mi0 Signature
Date. (22 ✓ 11 — J
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