HomeMy WebLinkAbout3107 Longhorn Ct - Applications/Reroof - 09/24/2018i it.y c t Planning Development, & Transportation Services
Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80824 Main: 970.416.2740 Fax: 970.224.6134
OVER-THE-COUNTER PERMITS ONLY
This applications is to be used to apply for the following permits only (check all that apply).
❑ Demolition (interior non. -structural) ❑ Electrical Alteration (not servi change) ❑ Gas Lighter 11 ❑ Gas Lo
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ( pp y)' Air Conditioning
❑ Ventilation ❑ Water Heater ❑Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make g
Ming ❑ Sewer Line ❑ Photo -voltaic
manufacturer).
Complete all a-21icable information on the application. Incomplete applications will not be accepted.
model and
AppUcation #_0 (� 2 —7 7 '46�/ V
Fir office use only Date C�C� b
Job Site Address (required) --"
1,bl- Value of Construction (labor, materials, profit)
Property Owner Name
1-
Address s
'Add t�1A�
—1
�-"(011iV1t
City/State
Zip
Phone
Applicant Name
A
Q S�210
Q r
� v ZZQ n$,7,q
;)CU(1� ��
ess
City/State
Zip
Phone
Contractor
-
Address
3- ss- ozon
11t✓
o . 2�� tACLtQiFe
City/State
�f3
Zip
(61.1625Q"�
Phone 1-7-0—
Contractor City of Ft, C ns
Sales Tax # Are
- sly/
Sales tax number isrequlredbyall
ou Paying taxes here or by
conmactors, Are you paying with your trust
report?
❑Here ❑Report
account?
❑ Yes ❑ No
Is this a residential or commercial project? Resiclential C7 Commercial
If residential, is it; 0 Single Family Detached Gl Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) 1:I Garage
If commercial, is it: ❑ Bank C] Bar ❑ Church GI Hotel/Motel ❑ Medical office ❑ Office 13 Retail
Is this building a years of age permit,
morurant e? Other❑ Yes ❑INo) If yes, you may need to contactHistorlcPreseruat/on
If this is for a demolition perrtsit, what year was the building constructed?
Description of vrork(afl ;vVlWVI! VIA i1i\ et
*If lawn sprinkler/;larkrlow preventer, must list licensed plumber. If first-time A/C/ must list licensed electrician.
Subcontractors: List the company name or Clty of Ft Collins licensee
ElectricianPlumber
Mechanical
I hereby acknowledge that I have read this application d state that the
comply with all raqui: ements contained herein and city ordinances an Permit is not valid UPitil it has been paid and issued.
Applicant;
Print Mamc:_
Revision date 2/6/2017
Roofer Other
cation is complete and correct. I agree
building construction. I know that a
Date 2N l