HomeMy WebLinkAbout1033 Driftwood Dr - Applications/Reroof - 10/06/2014Fort Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
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 )4 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 # 5 ` w '1 `q Date
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
$ '
ID35 DYE oo r.
100
Property Owner Name
r
Address
City/State Zip
60 Collimis 1052
Phone
i t l�
od i
CO
10 41fi.15
Applicant Name
Address
City/State Zip
Phone
110 Cpmntm
Irl, univis.CD U52s
coo '1g1.2 .
Contractor
Assurance Co.l�nc.IINNWeAW&
Address
City/State Zip
:r4- Col11CD Z5
Phone
C'161. 91.2SD2
Contractor City of Ft. Collins ales Tax #
Are you paying taxes here or by report?
Here ❑ Report
Sal4jfaxxnnumber isrequired byall contractors.
Are you paying with your trust account?
Yes ❑ No
Is this a residential or commercial project? ikllesidential ❑ Commercial
If residential, is it: Single Family Detached !�,Condo/townhome (single family attached) ❑ Duplex
h Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar '❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (ex lain)
Is this building 50 years of age or more? ❑ Yes No 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
*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 RooferQ- U 12 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: Print Name: eve yeV IdS Signatur Date Ib . Dlo • 20