HomeMy WebLinkAbout3406 Camelot Dr - Applications/Reroof - 09/25/2014F-n arftq, DavelcDisnhenc
city. C� 281 N. College Ave P.O. Box 580
Collins Fort Collins, 805
Phone 970-426-2740 Fax 224.6134
OVERmTHEaCOU TER PERMITS ONLY
This application Is to be used to apply for the following permits only (check all that apply). 0 Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) 0 Gas Ughter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacementoofing ❑ Sewer Line ❑ Photo -voltaic
❑ ventilation 0 Water -Heater 0 Water Line 0 Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applicatto s will no be accepted.
Application # b4 c) q iu)s Date
for ofte um 0*
lob Site Address (aqulmd) I Value of Construction (labor, materials, profit))
property Owner Name Address City/state Zip Phone
1 '- _ 11 , /1 1 i
Applicant Name Address City/State Zip Phone
# Ra Address City/State zip Phone
Contractor City of Ft. Collins Sales tax #
Swe tau m ffAW & rawftdbyad ronbarl+us
Are you.paying taxes here or by report? ❑ Here ❑ Report
Are you paying with your trust account? ❑ Yes -0 No
is this a residential or ai project? dential ❑ Commercial
if residential, Is It: Single Family Detached 13 Condo/townhome (single family attached) 0 Duplex
0 IdfarrdiY (apartment) ❑Garage
If commercial, is it: ❑ Bank 0 Bar 0 Church 0 Hotel/Motel 0 Medical office 0 Office 0 Retail
E3 Restaurant ❑ other (explain)
Is this building SO years of age or more? 0 Yes 40 rf yw you may need to contatHL4vdc Pre antlon
If this is for a demolition permit, what Year was the building Constructed?
Brprlor tv 1975 you will need an ashes apt to subm/t with this appllobba
*If lawn sprinkler/baddiow prever�ter, must list licensed plumber. If first time A/C, must list ncenseo etecmaan.
Subcont r LLst the companyname or aty offt Colllms //tense #
Elec6'IrJan
Plumber Ml_ Roofer Oder
I hereby ad=wledge that I have read this application and state that the above infometion is complete and correct I ague to
comply with all requlremelts contained herein and alyy ordinances and state laws regulating building wnstrucdon. I know that a
permit is m*vagd untfl It has been paid and issued.
Applicant
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