HomeMy WebLinkAbout1008 Driftwood Dr - Applications/Reroof - 01/19/2015ForCi ty of
t Collins
Planning, Development $ Transportation
281 N. College Ave
/
P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-274q Fax 224-6134
OVER-THE-COUNTER
This
PERMITS ONLY
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application is to be used to a 1 a
❑ Demolition (interior non-structural)3 Electriewl following
Alteration pnot'service chC change) all
GasaLighter❑0 Air
Gas LogConditioning
apply).
o Heating Unit ❑ Lawn Sprinkler d Mobile Home replacement d Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation d Water Heater ❑ Water line ❑ Wood/Pellet Stove (must
manufacturer), be EPA certified, provide make, model and
Complete all appllCable Information on the application. Incomplete applications will not be accepted.
Application #�' 1^_�?-- —_ > / �� 5-
for olce use only �8t5 sl ~
Job Site Addirm (required)
Value of ConstrucKon (labor, materials, profit)
/ L✓lJ � 1
Property Owner Name Address 2 pJDO
City/State
sv Zip Rhone
Applicant Name ZZ7— Ir Y
Address City/State zip
�>r .� • _ Phone
Contractor p q ! Address City/State Zip Phone
ICc10f,�c, �7 /
Contractor City of Ft. Collins Sales Tax #
salesraznumber is Are you paying taxes here or by report? 13Here O Report
ragirir6rlbyallmnbactors Are you paying with your trust account? ❑ Yes
'$No
Is this a residential or commercial project? Residential t Commercial
If residential, is it: 4i Single Family Deta v ❑ Condo/townhome (single family attached) Cl Duplex
❑ Multifamily (apartment) Cl Garage
IF commercial, is it: ❑ Bank ❑ Bar ❑ Church 17 Hotel/Motel # Medical office ❑ Office O Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? Dyes P No If yes, you may neen'to co/7 C7 NistoriC preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 19iS, you will need an asbestos assessment to submit with this app/icatlon.
Description of works . A J u _ _-
*If lawn sprinkler/backflow oreventer, must list licensed plumber. If nrst-time A/C, must list IicensW electrician.
Subcontractors: [Jst the Company name or City Of Ft C011117s license #
Electrician Prumbdr Mechanical Raer4r '' 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 regulaRng building construction. I know that a
permit is not valid until it has been paid and issued. k —1,5
Applicant:���r�
Print Name• � � !�� S(gnature��� '� uate