HomeMy WebLinkAbout1615 Fantail Ct - Applications/Reroof - 10/25/2011City of Planning, Development & Transportation
281 N. , a Ave P.O' Box 580 /
ort Collins Fort Collinshiss, CO 60524 / 1 �
Phone 970-416-2740 Fax 224-6134.n .�tL
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 ❑ Gas Log
❑ Heating Unit O Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ 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
Application # b I I 0q-1.10
For officr use only
Job Site Address (required)
Property Owner Name Address
Applicant Name
Contractor City of Ft Collins Sales Tax #
Sales Fax number is required by all contracwms
Address
Address
Incomplete applications will not be ac epted.. O .�
Date %O - a5 = // 't 14_Y
of Construction (labor,
City/State ZIP
14 UIKS M 82
Gty--nn,,
/-�State Zip
City/State . Zip
SaV-
Are you paying taxes here or by report?
Are you paying with your trust account?
..
, profit)
Phone 9n
Phone Wt
Phone 3d3
r�
eport
0
Is this a residential or commercial project? 21kesidential ❑ Commercial
If residential, Is It: 2-Single Family Detached ❑ Condo/rownhome (single `amily attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is It: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes 0'N0 lFyes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed? _
If prior to 1975, you will need an asbestos assessment to submit with this applicatlon.
Description of
•- Mvv" >N111 A1C11Ud'.Kiiuw preventer, must USE licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Collins llceltse ,
Electrician Plumber
Me"nlc3l 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: r
Print Name: rn_Ci 5 Ch Signature
_— Date ,—L��