HomeMy WebLinkAbout1638 Northbrook Ct - Applications/Reroof - 08/30/2018FliCity 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
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 # 6 0 � 3&d6 61.5�v
For office use only
Date_�y-18
Job Site Address (required) Value of Construction (labor, materials, profit)
Property Owner Name Address City/State Zip Phone
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Applicant Name Address City/State Zip Phone
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Contractor Address City/State Zip Phone
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Contractor City of Ft. Collins Sales Tax # w Are you paying taxes here or by report? M Here ❑ Report.
Sales tax number is required by a#. c6ift6rs Are you paying with your trust account? ❑ Yes 8 No
Is.this a residential or commerciel'pfoject? im Residential ❑ Commercial
If residential, is it: ❑, Sin6le`;Famil0 etached ❑ Condo/townhome (single family attached) XDuplex
0 Multifamily, ''apdrtmEnt) ❑ Garage
If commercial, is it: 40 Bunk 4 Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
0 Restaurant ° ❑ Other (explain)
Is this building 5%years of a ed'or more? ❑ Yesp 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��
5}z7i�Y
*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 # //K�
Electrician Plumber Mechanical Roofer i ` Ay22 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: I /%
Print Name: v `' C�� Signature Date o— 3b--�9
Revision date DM017