HomeMy WebLinkAbout2631 Brookwood Dr - Applications/Reroof - 10/07/2011Cityof Planning, Development & Transportation
} i , 281 N. College Ave P.O, Box 580
Foil Collins 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). ❑ 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 /1J-
manufacturer). iY
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # bm Date !d h
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
z(o 3 I e-00e cvoon 3 .O(
Property Owner Name Address
City/State Zip
Phone 01%0-2
j)kCKcf J-ftN'CE PEcK aU
6koo<000,6 FT.CoumS a - (r,87
Applicant Name Address
City/State Zip
Phone
5tl- 0-4F
Contractor Lic # R-2o-79 Address
City/State Zip.
Phone
PRO FE551on/AL_ R.00FIA & -5 0 LI+MA-Q ftkYArOA- cp U
3 U3- 6a
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
Here ❑ Report
Sales tax number is required byallconbactors.
Are you paying with your trust account?
❑ Yes .0 No .
Is this a residential or commercial project? 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 19 No if yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If pdor to 1975, you will need an asbestos assessment to submit with this application.
Description of work TF-ft2 o F F- 19.71 15n °f- IASTALL (o-7Sg
�U �R_n�M�tlSldtiA-c__
*If lawn sprinkler/bacidlow preventer, must list licensed plumber, If first-bme A/c, must list licensed electrician.
Subcontractors: List the company name or Cty 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:
Print Name: Signature Date
8