HomeMy WebLinkAbout2638 Southfield Ct - Applications/Reroof - 02/24/2015Planning, Development & Transportation
CF1111�'�►►►►/}Of Collins281 N. College Ave P.O. Box 580
` iI 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 El' 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 # b5c)1I t Date
For office use only
� -;q -15
g5
Job Site Address (required)
Value of Construction (labor, materials, profit)
'2�38 5okyiA1FiEr~D CT
000.0°
Property Owner Name Address
City/State
Zip
Phone
'jtiMkot4 QOby 2 3$ CovzNFioub CT
rz-/l V
6052-S
Applicant Name Address
City/State
r3Zip
&S•2
Phone
Co-i`r- -Z t '32z4 hnESqq QOR'De,
fC (0
&
Contractor Address
City/State
Zip
Phone
21ck. Co(4 L L C 32 7ryteS4 \& ,
—G
6 o
Contractor City of Ft. Collins Sales Tax #
Saes tax number Isrequ/redbyall con&actors Are you paying with your trust account?
❑ Yes ❑ No
is this a residential or commercial project? [Vesidenbal ❑ Commercial
If residential, is It: 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 ❑ No if yes, you may need to contact 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 w/th this application.
Description of work TGWP-, ocF stt It-tcrl.ES Zo sy 1 S ro¢y
w
*If lawn sprinklerlbackilow 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 #
Eleciridan Plumber Mechanical Roofer TR 6i�at-i + 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: Z tc��. Signature 9 Date a � 22 (' (5
Print Name: 9
r'