HomeMy WebLinkAbout4241 Breakwater Ct - Applications/Reroof - 08/05/2014Cit%t of Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Flirt Collins 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). 4 l G
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application #
For office use only
Date &- i "I
Job Site Address (required)
Value of Construction (labor, materials, profit)
C
`3 G
Property Owner Name Address
City/State Zip
Phone
Applicant Name Address
City/State Zip
Phone 470
Quaff �i Z
(cIBIS GT
310-35L
Contractor Address
—W
City/State Zip
Phone
svwl
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ®'here
❑ Report
Sales tax number is required by all contractors.
Are you paying with your trust account? ❑ Yes
M-No
Is this a residential or ce mercial project? IN Residential 0 Commercial
If residential, is it: 19 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 rkMo 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 wibb this application.
Description of
I s-h�, ac�SS • '
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electridan.
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: -e �_
Print Name: & Signature k`��1y Date 5 -1