HomeMy WebLinkAbout2006 Newcastle Ct - Applications/Reroof - 09/12/2017City of
Fort Collins
Planning, Development & Transportation
281 N College Ave P 0 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). ❑ 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 #_B 176BY 1 X Date 1 " I q-1 Z -17
For office use only
Job Site Address (requrred)
a� Newu_�-, 41
Value of Construction (labor, materials, profit)
5
ti070
Property Owner Name Address City/State Zip Phone
DA05 ZW '46t,Kolf i.- s C'o go S2(o pro 3os931p
Applicant Name Address City/State Zip Phone
1:190 Stro-6130-1- lo2S Sr s `ire L.0je CZ &IS3 I coo Dg1C)
Contractor Address
City/State Zip Phone
Adi�layu_airt02 La.
LbOcw.L en �O53-7 R202t4 7C63
Contractor City of Ft Collins Sales Tax #
Are you paying taxes here or by report? X Here ❑ Report
Sales tax number isrequwrcdbyall contractors
Are you paying with your trust account? P'Yes ❑ No
Is this a residential or commercial projecO El Residential ❑ Commercial
If residential, is it 0 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 morel [:]Yes ❑ No If yes, you may need to contact Histonc Preservation
If this is for a demolition permit, what year was the building constructed?
Ifpnor to 1975, you will need an asbestos assessment to submIt with this application
ZW
*If lawn sprinkler/backfiow preventer, must list licensed plumber If first-time A/C, must list licensed elc6rician
Subcontractors List the company name or City of Ft Callen license #
Electrician Plumber Mechanical Roofer K 2 ` O 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 law egulating building construction I know that a
permit is not valid until it has been paid and issued.
Applicant._ ,/� �yl� Print Nam Nam J/Z�"' '�' ' Signature Date f