HomeMy WebLinkAbout1633 Fantail Ct - Applications/Reroof - 07/22/2014City, Pla Transportalillon
Collins OX 580
Phone 970416-2740 Fax 224-61M
OVER-THSCOUNTER. 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 j fteration (not service change) ❑ Gas Lighter 13 Gas Log
❑ Heating Unit O Lawn Sprinkler ❑ Mobile Home replacement 09 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 # ��
Forofike um only
Incomplete applications will not be accepted.
Date � a
Job Site Address (rawiled) Value of Construction (labor, materials, profit)
Property Owner Na Address City/Stabs Zip Phone
T
Si' v vow ez.PoA � L_ 2o5;y d - ya$'
Applicant Name Address CRY/ate Zip Phone
Contractor Address
yt L s 4c--uj . (mob N. C
Contractor City of Ft. Collins Sales Tax #
sabes tar Bomber iafe( d bra# avbarurs.
.-15 39
city/State Zip Phone
Are you paying UDm here or by report? S Here D Report
Are you payer with your trust account? 8 Yes 13 No
Is this a residential or commerdal project? ® RmWentlal ❑ Omnaidal
If residential, is It. ® Single Family Detadhed 0 Condo/tDwnhOrne (single family attached) ❑ Duplex
❑ multifamily (apartment) D Garage
If commercial, Is it: ❑ Bank ❑ ear ❑ Church 0 Hotel/Motel 0 Medical office O Office ❑ Retail
❑ Restaurant o other (amain)
Is this building 50 years of age or more? ❑ Yes igNo IPyes, you maythxd to uwbd tltsiartc pnweYebbn
If this is for a demolition permit; what year was the building oorstructed?
If prior to 1975, ynu w1# needan asbesft assenent to.sribrnit *&9 this awl
*If lawn sprinIder/baddlow, preventer, must pst iimnsed
Subcont actorm Ght bte cu psv aumoe ar Cry o0T t
EkKtidan
if firaAkne A/C. must list licensed electrician.
I hereby acknowledge that I have read this application ad shine that the above inkMINtion is aor O to and oarrecL I agree to
comply with all requirements mntalnect herein and city gdlnartces and state laws regulating buftng mrWniction. i know, that a
permit is not vandl until it has been paid shed issued.
Aptaimmt: Rts� CPt Print Name:- �<?� _ Date
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