HomeMy WebLinkAbout208 Egyptian Ct - Applications/Reroof - 09/22/2011Planning, Development &Transportation
City Of 291 N. College Ave P.O. Box 580
rt Coll , s 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 # ill 0 "fS*j-- ��� Date
For office use only
lid
Is this a residential or commercial project? VResidential ❑ Commercial
If residential, Is It: Vsingle 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 Q/No If yes, you may need to contact Historic PresemaUon
If this Is for a demolition permit, what year was the building constructed?
Ifpeor to 1975, you will need an asbestos assessment to submit with this applrcadon.
Description of work
*If lawn sprinkler/baddlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or QY of At Collins license If
Sectrician PlumlAr
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 constructlon. i know that a
permit 1s not valid until it has been paid and issued.
Applicant:()
Print Name: ignatu I Date