HomeMy WebLinkAbout912 Bitterbrush Ln - Applications/Reroof - 07/20/2017Jul 20 17 09:22a Severe Weather Roofing 9702233383 p.2
Planning, Development, & Transportation Services
,.Fort Collins Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main: 970.416.2740 Fax: 970.224.6134
A
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 certifled, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application #�b I I Ib
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For office use only
Date -7,� o 11-o I -1
Job Site Address (required) Value of Construction (labor, materials, profit)
Q12 'b'A e ov
Property Owner Name Anddress City/State Zip Phone
Applicant Name Address City/State Zip Phone
Contractor Address City/state Tip Phone
Q. S. C 220 f i o S L 4�0 -ZZ3-Z
Contractor City of Ft. Collins Sales Ta # Are you paying taxes here or by report? ❑ Here 0 Report
sales tar numbe-isrequbedbya#cai6adort Are you paying with your trust account? ❑Yes ❑ No
Is this a residenti Vrc
mercial project? idential ❑ Commercial
If residentialis itngle Family Deta ❑ Condo/townhome (single family attached) ❑ Duplex
ultifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Mobel ❑ 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?
Description of w rk M0042b. 2s A '
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*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: tlst the company name or City of Ft Coffins license #
Electrician 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:
Print Name:�f' ��Je-- J Signature Date %Q ZOl7
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Revislrn date 2,W4317