HomeMy WebLinkAbout2238 Moffett Dr - Applications/Reroof - 09/26/2016City of Planning, Development & Transportation
Fort Collins 281 N. College Ave P.O. Box 580
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). O 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 ak o and
manufacturer). I
��`��Complete all applicable information on the application. Incomplete applications w'll not b accepted.
Application # Date ` .21, 2 0/
For olfce use only
Is this a residential or commercial project? 16 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 J9t 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 will need an asbestos assessment to submit with this application.
Description of work etwove
%L� laces w Sy,y e e
I`If lawn sprinkler%backflow preventer, must list licensed plumber. If first-time A/C, must list licensed
Subcontractors: List the company name or City of Ft Collins license #
Electrician Plumber
Mechanical Roofer
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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: y,��n /''I Y r 5 �6('S Signature