HomeMy WebLinkAbout301 Butch Cassidy Dr - Applications/Reroof - 09/10/2018City of planning, Development, & Transportation Services
�t 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 ARoofing ❑ 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 # P 14nu-7-700 Date
Foroliice use only
Job Site Address (requlred) Value of Construction (labor, materials, profit)
cal IPAVM OaS�iAl Dr, [3.00. UD
Property 0 ner Name Address City/State Zip Phone
2�50 u�cel�l a D(. nS a2 �f1(� 2Z3 S
A licant Name Address City/State Zip Phone
Contractor Address City/StatZip Phone
IV O fi ` CLAW t I" Y D 112
Contractor City of Ft. Co Ins Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
sales xnuerisrequired byallcontractors Are you paying with your trust account? ❑ Yes ❑ No
U L't
Is this a residential or commercial project? Residential d Commercial
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 (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 u
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: L& the company name or City of Ft Collins license # ��f� +�
Electrician Plumber Mechanical Roofer 1� _ �� `���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
---itff�has been paid and issued.
Applicant:t I 1 p'p I%� u -- O�
Print Name: \ 1 ` 1 I I`j lignature Date 1 `b
Revislon dale MQ017
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