HomeMy WebLinkAbout1106 Deercroft Ct - Applications/Reroof - 10/28/2011City Of Planning, Development & Transportation
Fort Collins For N. College Ave P.O. Box 580
Fort Collins,
CO 80524
Phone 970-41616-27402740 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 ❑ Gas Log
❑ Heating Unit ❑ 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 #
For office use only
Incomplete applications will not be accepted.
Date
Job Site Address (required) Value of Con$truction (labor, m erials, profit)
1166 DccrcroF? 67• $ Y/9s°°� 27.E
Property Owner Name Address
City/Statg Zip
Phone
lv/IArd 1/06 RercruPi 6F, C.
2z7 - /yxl
Applicant Name Address
City/State Zip
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Phone
A'-� LIP/1 Z CIAWd s�-
r'T.' aw
S�- 22,?z
Contractor Lic # Address
City/State Zip
Phone
A05-Mav R�v�� 9--l222
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
Here ❑ Report
Sales tax number is required by all contractors.
Are you paying with your trust account?
❑ Yes ❑ No
q/067
Is this a residential or commercial projects Residential ❑ Commercial
If residential, is it: Single Family Detached ❑ Condo/townhome (single family 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'X No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If pnor to 1975, you will need an asbestos assessment to submit with this application.
Description of work %ca ✓ aG� /- ZA 1 c✓ G.-d r�sia /) fo L,✓ rd.� a/��
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/c, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license # -
Electrician 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: r11 v�
Print Name: / �i�fk9'� Signature G�i/�� Date Za �- 2 0//