HomeMy WebLinkAbout1424 Cactus Ct - Applications/Reroof - 08/25/2011City f Planning, Development & Transportation
FY o291 N, College Ave P.0, Box 580
ort Collins Fort Collins, CO 80524
Phone 970-416-2740 Fax 22 4-6 13 4
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). C Air Conditioning
d Demolition (interior non-s;:=ural) ❑ Electrical Alteration (net service change) C Gas Lighter 0 Gas Log
G Heating Unit 1 Lawn Sprinkler ❑ Mobile Home replacament ❑ Roofing ❑ Sewer Line G Photo -voltaic
❑ Ventilation C Water Heater Li Water Line G Wood/Pellet Stove (must be EPA certified, provide make, modei and
manufacturer).
Complete all applic le information on the application. Incomplete applications will not be accepted.
AppliCatiOri j (J (0 3 Date _ -
For oFca use only
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Property Owner Name Address
City/State
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Phone 1776
. / 660) 57 9 6 StZav&jAd 69
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P-72 !gLb
Applicant Name Addres-c
City/State
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Phone (3 70
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6er4-s oQ wtndsor Co
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663-oao
Cont rcor Uc I" Address
Cty/Ste
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Phone
Aad F%jan S 12 -
Conti actor City of Ft Collins Sales Tax
Are you paying taxes here or by report?
Here ❑ Repo`
Sa/esbxnumbu /sreaur�ad5yanconte� or
a9os(n
Are ycu paying with your truce account?
es ❑ No
Is this a residential orZommerdal proje^_t? KResidentiaf Elnn CoerC,al
If re_idential, is it: Pyfngle Family De ached 0 Condo/townhome (single Family attached) ❑ Duplex
0 Kultiftmily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ 22r ❑ Cnurch ❑ Hotel/Motel ❑ Medical cEice ❑' Of ;ce ❑ Retail
❑ Resaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes �No If yes; youm2yne_dtoCorita'CtHi5-40 CPreservatlon
If this is for a demolition permit, what year was the building constructed?
If prfcr to 1975, you will need an submit wkJ this application.
of work
R
*If fawn sprinkler/bade;ew pri:venter, must list licensed plumFer. If first -tine AjC, rniu!2tt lie` licensed efezzidan.
5ubeontracters: L%s, ti,e c.mcary come cr Citj ci Fc Collins license (�
E:eC'c'zn Glurber Met52ricel Rcc cr eLlj tX�dd2 GCher
I hereby adnew!edee that I have read this apcilc_ cn and state that the abcye inkanaton is compiete and tenet . I acre to
compfy with all requirements cencained "herein znd city ordnances and slag laws r yulatfne �.uficina cons;: ucticn. I know thzt a
permit is not valid until it has been paid and issued.
Applicant: �] �,I ✓
Print Name: i Ca CI. 1 mEE Signah: \ Data
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