HomeMy WebLinkAbout3207 Killdeer Dr - Applications/Reroof - 08/27/2012City of Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins 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 ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer). G
Complete all applicable information on the application. Incomplete applications will not be accepted. po -0o
Application # Date Z "? - I Z
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
32Oi k\LLbEt-,l2- USL\VL' 1 $ G C)00-;
Property Owner Name Address
City/State
Zip
Phone
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Applicant Name Address
City/State
Zip
Phone
Contractor Lic # Address
City/State
Zip
Phone 011-60
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here
or by report?
® Here ❑ Report
Sales tax number is required by all contractors.
Are you paying with your trust account?
❑ Yes 9 No
Is this a residential or commercial project? & Residential ❑ 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 mayneed to contactHistoric Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work RL- - (wu F 00 C OM AoS 1 L
SLL 1nxcl l)AtL AtL-w.
*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
Mechanical Roofer 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: _� oVNn M'N rcv,\Jc& Signature
Date g A 3 h 'Z
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