HomeMy WebLinkAbout2113 Kirkwood Ct - Applications/Reroof - 07/13/2017CI Of Planning, Development & Transportation
Fort Cottins
Fort N. College Ave P.O. Box 580
i7 Collins, CO80524
Phone 970-416-27402740 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)
Complete all applicable information on the application. Incomplete applications will not be accepted
Application # Date
For ofte use only
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Job Site Address (required)
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Value of Construction(labor, materials, prof
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Property Owner Name
Address
City/State Zip
Phone
osa 9'7Lo5-37.1-ysa0
ApplicAt Name
Address
City/State Zip
Phone
Contractor
0 o-o
Address
ity/State Zip
Phone
Contractor City of Ft. Collins Sales Tax # Are yod paying taxes here or by report?
Sales lax number isrequired byall mntractors Are you paying with your trust account?
❑ Here �rt
❑ Yes ct_f —
Is this a residential or coglimercial project? OResidential ❑ 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 Ifyes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Ifjonor to 1975, you will need an asbestos assessment to submit with this application.
Description of work
IN
*If lawn spnnkler/ba�kflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or Gty of ft Collins license #
Electnoan I Plumber 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: ((''�� q ((��
Print Name: `JaU C^� Signature Zaxa _ Date