HomeMy WebLinkAbout316 Butch Cassidy Dr - Applications/Reroof - 09/10/2018F6City 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 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 # f) 1-Oon-m /
For office use only
Date r -o - t v
.bob Site Address (required) Value of Construction (labor, materials, profit)
JIB dU h CASsl�i�l Dr 3 . ov
Property O ner Name Address City/State Zip Phone
2�5 D �c�I�,� a 0+ nS rJ 2 qlt - M 5
A pliant Name Address City/State Zip Phone
" L7L CikZ)Y
Contractor Address City/Stat Zip Phone
ofi t� S "�� �► C(Agvm I 0/01 o'12 `_X'\"2 fp
Contractor City of Ft. Co Ins Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
sales,kxnui�rbefilsrreq`irree-dbya#cont7actors Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? Residential ❑ Commercial
If residential, is it: ❑ Single Family Detached LCondo/townhome (single family attached) El 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 mayneed to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work —VeU
*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 - q) r 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: \ 1 U 1 lignature Date
Rehsion date W12017
Rol