HomeMy WebLinkAbout4806 LANGDALE CT - APPLICATIONS - 3/24/201603/24/2016 16:08 9705930124 GOLD ROOFING INC PAGE 01/01
Planning, Development & Transportation
16ftCCity281 N. College Ave P.O. Sox s80
oltins:Qf Fort Collins, CO $0524
f a�� 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). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter IO Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement XRoofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water line 17 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 # b l Lao i 5 d9 Date
For O19`M use Only
Is this a residential or commercial project? VResidential ❑ Commercial
If residential, is it: (mingle Family Detached ❑ Condo/townhome (single family attached) 13 Duplex
❑'Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Hank ❑ ear ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes rErho Ifyes, you mayneeidtto C017tactHi5toifcpresemYabon
If this is for a demolition permit, what year was the building constructed?
Ifprlorto 1975, you wuineed an 75bastosasse"nent to subm/t with this application,
of work
Pw 5 fib
le —
*If lawn sprinkler/backnow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: 41&the company name or City of Ft Co/l/ns license g
SeCbician Plumber Mechanical 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:1?*Ar Signature r r9i!
Date