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HomeMy WebLinkAbout601 Breakwater Dr - Applications/Reroof - 12/17/2014/10 ,�i Coll1115 Cityof ptannhtg, Development &Transportation 281 N. College Ave P.O. Box 580 Fort Collins, CO 80524 Phone 9701i1&27411 Fax 224.6134 OVER-TH:E-COUNTER PERMITS ONLY This application is to be used to apply for the following Permits only (check At that apply), 0 Air Conditioning 0 Aemolldon anterior non-structural) ❑ Electrical Ahmition (not service change) O Qas Lighter ❑ Gae Log O Heating Unit ❑ Lawn Sprinkler Q Mobile ;come replacement; 0 Roofing b Sewer Line ❑ Photo -voltaic ❑ Ventilation 0 Water Heater 0 Water Une. 0 Wood/Pellet Stove (must be EPA certified, provide make, model and manufacturer). Complete all applicable inforrnatlon on the appileation. Incomplete applleationa will not be accepted. Applicd1on # Date e. ec Z Ol ai�n� y Job Site Address (ra7aft dJ Value of Construction (labor, matergb, prom) O 3,600.o0 Property Owner Nance Address tfty/i mate Zip • Phone QTO 9,016L, hsalp-pi t Applicant Name Address e City/state ZIP • Phone �� �, T a - Contractor Address Oty/Stata Zip • Phone 2N ST1/ 7~ �JII .O,ib NS (/O&sa7 970M 9 Contractor City of Ft Cellirm Sales Tax # Are you paying taxes hoe or by report? Here ❑ Report SAI rarnrx17ara•n sgy/r asm csox Are you paying with your trust account? Xes ❑ No �iCernt�f #' Q—iS$ Is this a resldentiai'or cornntedal project? APReddentlal C1 Commmcial If residenttal, is lb i SIngle t'tmRy Oetadred 17 Condo/mwnhome (single famty attached) Cl Duplex 17 Multifamily (apartmeno 0 Garage Vcommercial, Is IL O Bank Cl Bar 1] church Q Hoteftlel Cl Medial office © Office 0 Retail 0 Refturant 13.0ther (explain) Is this b uWfng so years of age or more? 13Yes CI no Dyer, you mayneeym mrdtuu Htstoryc rscst/e„ If this Is for a demolition permiq What year was the building constructed? Dprlorto JM,, yod WAYneed an adestasamwnantto mftkha aidsaAmyaft r. DeScriptUcm of work w f lawn sPMft/bB"*w preventer, must Ilst liamised Plumber. If first-time lac, must Ifst =1�MmdezdM"dian. subcoCk actow.- LC�ttlaewn>F�rYnameorC![yafFtLbDll d` gectrldan_ Plumbs MectgtireloferOther; I hereby adurowledge thatI ban read this application and state that the above Information Is conipli Ae and correct I agree to comply with all raqukeme"IS aftined herein and citymdirlarMS g building nstructlan. I know that permit is nut Valid unt11 it huts Peen paidt and teamed. pp