HomeMy WebLinkAbout406 Chukar Ct - Applications/Reroof - 08/22/2014Planning, Development & Transportation
City, of 281 N. College Ave P.O. Box 580
F6r't Collins Fort Collins, CO 80524
`- Phone 970-416-2740 Fax 224-6134
�)10,15
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. Incomplete applications will not be accepted.
Application # F-5I 4t)(01?�S Date
For ofl%e use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
Property Owner Name Address
City/State
Zip
Phone
Applicant Name Address
City/State
Zip
Phone
MIkE E -mm Ail i►tl•T
(olltne
Nv5 -
323-2103
Contractor Address
City/State
Zip
Phone
Contractor City of Ft. Collins Sales Tax #
sales tax number is required by all conbactom Are you paying with your trust account?
❑ Yes 2-No
Is this a residential or cogmercial project? ff-Residential ❑ Commercial
If residential, is it: O'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 ❑ No If yes, 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 application.
Description of work �' �- �'"'
'A 0 t^M i-n rA r P z
*If lawn sprinkler/bacldiow 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: 1�,l C
Print Name: Pike 'G Ltxl." Signature jy�or Date