HomeMy WebLinkAbout1648 Dogwood Ct - Applications/Reroof - 06/30/2014City of r1 Planning, Development &Transportation
1 1�+#� �®���1 IS 281 N. College Ave P.O. Box 580
F6
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
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # YC��Date (9 ✓ -H
For office use only
`L�1
Job Site Address (required)
Value of Construction (labor, materials, profit)
8 ,�,�
3000.00
Property Owner Nam
Address
City/State Zip Phone
(fod0 1, &Jd 1041
160&
lJ Oq -9/76
ApplicarAame
Address
City/State Zip Phone
Contractor
(ti .15 A00J`7e-
Address
City/State Zip Phone
►s.�
Contractor City of Ft. Collin ax #
Sales tax number isrequired byall contractors. #0b2'7 7
Are you paying with your trust account? Does ❑ No
Is this a residential or commercial project? ,EtLesidential ❑ Commercial
If residential, is it: r�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 5o years of age or more? ❑ Yes Y RO 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 w/ll need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/backflow 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: G( -�(f -� C
Print Nam Signatu Date