HomeMy WebLinkAbout2115 Sweetwater Creek Dr - Applications/Reroof - 08/04/2014City,Of Planning, Development & Transportation
FoCollins 281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-41616-2740740 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. Incomplete applications will not be accepted.
Application # bi Lt S 01
For office use only
Date 5
Job Site Address (required)
Value of Construction (labor, materials, profit)
6V
Property Owner Name / Address
�
City/State
/ Zip Phone
�w ace, w,c�o/Q5 / ,-eek
k
d/� 3x -03
Applicant Name Address .
City/State
Zip Phone
GL'.C.(0,
Contractor �j�p / // Address //ry,
liGifCktAkt_ `A/lA/(i�i AW 5 Me
J JCity/State ,p'
` //I yc
f(((����(ZZii/lp 2 Phonee7r�%`/ %% 7
0 8�q o rJ0! Or/P
Contractor City of Ft. Collins Sales Tax #
Sales tax number is required by all contractors
""11
Are you paying with your trust account? ❑ Yes /Icu No
Is this a residential or commercial project? Residential ❑ Commercial
If residential, is it: OSingle Family Detache ❑ Condo/townhome (single family attached) ❑ Duplex
�b 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 Nc If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the uilding constructed?
If prior to 1975, you wlll need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/backnow 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
5
1@1117M
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: JcaJt alr.e44' Signature
Date U z
rI