HomeMy WebLinkAbout900 Driftwood Dr - Applications/Reroof - 08/08/2014 (2)�CI Of Planning, Development & Transportation
or ` Collinsor N. College Ave P.O. Box 580
Fort 1 .7 Collins, CO 80524
�y�_ 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 ElMobile Home replacement ❑ Roofing ❑ SeweriLine El Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer). i A —
Complete all applicable information on the application.
Application # �514��V V
For office use only
Incomplete applications willl /not be accept UP
Date
Job Site Address (required
Hob{ �
Value of Construction (labor, materials, profit) .
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C/ doves
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Property Owner Name
Address
City/State i Zip
Phone
Applicant Name
Address
City/state Zip
Phone
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BSI . C
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�70-610.19
Contractor
Address
City/State Zip
Phone
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Contractor City of Ft. Colli s S es Tax #
Sales tax number isrequired byall contractors0877 Are you
paying with your trust! account?
i
Of -Yes ❑NO
Is this a residential or commercial project? 1 Residential ❑ Commercial
If residential, is it: J!�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 XNo if yes, you may need to conta�t Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Ifprior to 1975, you will need an asbestos assessment to submit with this application, ��
Description of work /
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t a IG�„�1n4
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician. Sko-j U6
Subcontractors: List the company name or City of Ft Collins license # i
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: 3C) h '� 4,5 Si ate
natu /
Print Name: hP� g
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