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HomeMy WebLinkAbout3206 Camelot Dr - Applications/Reroof - 10/01/2014This application is to be used to apply for the following permit$ only (check all that apply). ❑ Air Condltloning ❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) 0 Gas Lighter 0 Gas Log tI Heating Unit El Lawn Sprinkler ❑ Mobile Home replacement l7 Roofing ❑ Sewer Line ❑ Photo -voltaic ❑ Ventilation 0 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. Appllcatlon # 90144 1132 Date For office use Ori/y ]ob Site Address (requifed) 3 49-6 U Cc! —ping t'�r. Value of Construction (labor, materials, profit) � t I goo Pro erty owner Name Address Sa e- ApAlicant dame Address Cily%state Zip Phone ,-69o-L9s13 City/state zip Phone q- () (a] . 1; L' aiU 'floc Contractor Address /state Zip Phone Contractor City of Ft. Collins Sales Tax 4 Sarestax number isrFaWredbYelf Ontraetom Are you paying with your trust account?* Yes ❑ No Is this a residential or commercial project? .1gResldential ❑ Commerclal IP residential, Is It: -Single Family Detached ❑ Condo/townhome (single family attached) 0 Duplex a Multifamily (apartment) O Garage If commerclal, is It. 0 Bank ❑ Bar 13 Church ❑ tfotel/Motel 0 Medical office ❑ Oflnce © Retail 0 Restaurant ❑ other (explain) Is this building So years of age or more? Ci Yes ❑ Ne If yes, ynu may need t+9 contactHlstnric Pr2seNadon IF this is for a demolition permit, what year was the building constructed? Ifptfor to 1975, you will need an asbrwstas assessment to subnrft with this appllcadan. Description of work *IF lawn sprinkler/backflow preventer, must IisY licensed plurnber. If first-time A/C, must itst licensed electrician. Subcontractors: U5tfatamrtanynameorC/tyofFttblllnslirense.F` El&dr1dan Plumber Mechanical Raafer Other I hereby acknowledge than have read this appilwtton 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: �~ l Signature Print lYama: _ � • •