HomeMy WebLinkAbout1602 Northbrook Ct - Applications/Reroof - 01/11/2018City of 281 N. College Ave P.O. pox "u
F®rt co11`ns Fort Collins, CO 0524
Phone 970-416-27402740 Fax 224-6134
OVERTNE-COUNTER PERMITS ONLY
permits only (Check all that apply). 0 Air Conditioning
This application is to be UBed�to apply for rical
the followingas p Demolition (interiors no Spructu al) Mobile Home0 Electlreplaceteration ment(nots ervice ❑ Roofing 90 Sewer Une ht❑ Ph❑Gas Log oltac
0 Heating Unit 0 LaiiI
❑ Ventilation ❑ waterHeater6 Water Line CIWood/Pellet Stove (must be EPA certrfied, provide make. model and
manufacturer). 12q ?d
Complete all applicable infortnation on the application. Incomplete agolieations will not be aocepted.1� �36
Application # 6��jZL7
for olfrC'e use o
lob Site Address (required)
/ 08
Property owner Name
Aoolicant Name „
Date 1/'��
n Value of Construction (labor, materials, profit))
i tnn PTlI PPnfl� / �r . Y7�l �17 �7 7 + ' 13
Address
,
Address
City/State. o zip phone
Zip , Phone
City/State Zip Phone
j Address ti -) .
Con or / zip. Phone
AAXrI - S��=C>
f Ft. Collins Sales Tax � Are you paying taxes here or by report? a❑ Here C,] Report
Contractor City onumbby all tprihdd0a '� Are you paying with your trust account? Yes W No
Sales lax er is Ft . C
Is this a residential or
If residential, is it: i
If commercial, is it
I Is this building SO
If this is for a den
mmercial project? 40 Residential ❑ Commercial t`
�� Fagoir Betsehe� 0 Condo/townhome (single family attached) QX Duplex
Multifamily (apartment) 0 Garage
Bank 0 Bar O Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
Restaurant 0 Other (explain)
i of age or more? D Yes %p No If yes, you may need to contact NiBtolic Preservation
on permit, what year was the building constructed?
Description of work' 2 fr'J o 30
GOLEIS
Sfa,eY
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must, list licensed electrician. i
Subcontractors: List the company name or City of R Collins license f '
Electriaar. L Plumber Mechanical Roofer /� Other
i
i hereby acknowledge Mat: nave 'eao this application and state that the above information is complete and correct. : agree to
:omply with all requirer7 eats :pntained herein and city ordinances and state laws'egulating bulding construction. I know that a
permit is not valid until it has been paid and issued.
Applicant: ( / / -
Print Name:V`� 7 ! -��� L signature /� Date _