HomeMy WebLinkAbout2616 Killdeer Dr - Applications/Reroof - 10/30/2017LiiyCi FoPlanning, Development, & Tra�nSPOTW On aisrVICGS
rt Collins Community Development & Neighborhood Services
_ 281 North College Avenue
Fort Collins, CO 80524 Main: 97OA162740 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 ❑ Rooting ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ WoodlPellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application #,
81 D1343 Date
Forofilce use only
lob Site Address (required) Value of Construction (labor, materials, profit)
(0 Co i'
Property Owner Name Address City/State Zip Phone
,a + 11 Fo ' — r21� ' -23-
App cant Name t Address City/State ( tZip Phone p�
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Contractor Address City/State Zip Phone
C,70
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Contractor City of FL Collins Sales Tax # Are you paying taxes here or by report? 1� Iere ❑ Report
Sales tau nwnberb miubed by all mnbactors Are you paying with your trust account? )d Yes ❑ No
Is this a residential or commercial project? Residential O Commercial
If residential, is it: 12 Single Family Detached ❑ Cwrdo/bownhome (single family attached) ❑ Duplex
O Multifamily (apartment) O Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retall
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? O Yes ❑ No 9yes, you may need m caaW HLstoiicfireservation
If this is for a demolition permit, what year was the building constructed?
Description of work QM J '� I CL L
*If lawn sprinklerlbaddiow prevenber, must list licensed plumber. If first-time A/C, must list licensed eieetriclan.
Subeontraebohs: L&Me company name orCi'LyofFt Collkshbwse #
Becbidan Plumber. Mechanirai 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!�
/I t �iMrASorr signature
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