HomeMy WebLinkAbout1712 Briargate Ct - Applications/Reroof - 06/21/2016�)� �� Planning, Development & Transportation
^� �®����� 281 N. College Ave P.O. Box 580 s�s5
�.or Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
13 z- 7
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 El Lawn Sprinkler ❑ Mobile Home replacement ery 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.
7
Application # 2 �! q -/ Date & I IL. 4
For office use only / S,�� 'qcCL S S
lob Site Address (required).
Value of Construction (labor, materials, profit)
/'71-2- i''a/' R- (0Vr4_
Property Owner Name Address
City/State Zip
Phone
Applicant Name ° /13o Address
City/State Zip
Phone
P , �f
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56 - m&3
Contractor Address
City/State Zip
Phone
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
ort
❑ Here :tcp
Sales tax number is required by all contractors.
Are you paying with your trust account?
❑ Yes
Is this a residential or co mercial project? UKesidential ❑ Commercial
If residential, is it: WSingle 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?
If prior to 1975, you MY need an asbestos assessment to submit. with this application.
Description of work
*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 Plumber Mechanical Roofer i�Q 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: J
Print Name: c /*ogv & • s-4o�� Signature �� ��./�' Date ���I