HomeMy WebLinkAbout1927 Lookout Ln - Applications/Reroof - 10/19/2017City of 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
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 EIIRoofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer). i28 2f4
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # f \-y)(Olstr% Date 10.1q 41
For office use only
Sob Site Address (required) Value of Construction (labor, materials, profit)
Property Owner Name Address City/State Zip Phone
u 1CQT 100 (A F(- t Y0524 930a lg 393
�plicant Name Address City/State Zip Phone
La, �A 2-40D it A44 k I r do Sa 2 -38 3
Contractod Address City/State Zip Phone
Contractor City of Ft. Coll s Sales J& # Are you paying taxes here or by report? ❑ Here ❑ Report
sales tax number isreguIredbyall contractors . Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential.or commercial project? EMesidential ❑ Commercial
If residential, is it: C'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 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 3 e - 5
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*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins 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 Nam,7ELI�Jl I Signature Date
Revision date 2/6/2017