HomeMy WebLinkAbout2613 Mckeag Dr - Applications/Reroof - 09/27/2017/F6City of Planning, Development & Transportation Services
rt Collins Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main: 970.416.2740 Fax 970.224.6134
I-1(p.—IS
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 15 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 # 9110 (loa(p Date
For office use only
lob Site Address (required) Value of _Construction (labor, materials, profit)
Property Owper Name Address City/State Zip Phone
Applicant Nam Addrey City/State Zip Phone
Mu l ,b+ a44CS 14,Celt o 2
Contractor Address City/State Zip Phone
-Z57-QW City of Ft. Collins f4es Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
saiestaxnumderisrequiiedbyaacnno-adWs Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or �co��erdal project? esidential ❑ Commercial
M 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 (explai
Is this building 50 years of age or more? ❑ Yes o If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work C' C
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: list Me company name or City of Ft Collins liciari.se #
Eledridan Plumber Mechanical Roofer ther
I hereby acknowledge that I have read this application and state that the above information is complete and rest. I agree to
comply with all requirements contained herein and city ordinances and state laws regulating building constru on. I know that a
permit is not valid until it has been paid and issued.
Applicant:
Print Name: l' Signature Date
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