HomeMy WebLinkAbout907 Breakwater Dr - Applications/Reroof - 07/28/2014Jul31 1402:29p Northern Lights
303-774-1206 p.1
Fort Collins
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Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 60524
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
q Demolition (interior non-structural) ❑Electrical Alteration (not se ce change) ❑Gas Lighter ❑Gas Log
❑ Heating Unit ❑ Lawm 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. Incomplete applications will not be accepted.
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Application # l ` oV ro v Date a -4- 20 (`{
For of lice use only
Si6B Address (tgwfeaI
Value of Construction (labor, materials, profit)
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Property Owner Name Address
Gty/State Zip Phone
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Applicant Name Address
City/State Zip Phone
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Contractor Address
City/State Zip Phone
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Contractor City of Ft Collins Sales Tax #
Are you paying taxes here or by report? Jig Here ❑ Report
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Are you paying with your trustaocount? ❑Yes (KNo
Is this a residential or& mmercial project? M Residential ❑ Commercial
If residential, is it: �( Single Family Detach m❑ ❑ Condo/townhoe (single family attached) Duplex
(_Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑'Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
O Restaurant ❑ Other (explain)
Is this building 50 years of agile or more? ❑ Yes ❑ No If yes, you may need to currt7d Htstr Ptaseivabon
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, kav will need an asbestos assessment to submit with this application.
Description of work )2 E f uEC* & 3 5 ig Mixif- w l A P44-F- Lknw r nr ta!; Wwall t f S
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*If lawn sprinkler/bacldbw preventer, must list licensed plumber. If first-time NQ must list licensed electrician.
Subcontractors. List Use company name or City of i3 Collins h ense 0
Electrician Plumber mechanical Roofer
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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 pail and issued.
Appii ant: rr''
PrintName:A l/YI�S Ho0y1 Signature
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