HomeMy WebLinkAbout863 Campfire Dr - Applications/Reroof - 09/12/2018OVER-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 #, �3 � Z b-4 q aZ Date g 1 1 I
For office use only
)o Sibe Address (rWu/ied) V� i f Construction pabor, materials, profit) I S
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Property Owner Name II Address Gty/Staabe Zf/p Phone
C I� �D �� r`e-
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ApplIcani Name Address Gty/Stabe Zip Phone
Contractor Address City/Stabe Zip Phone
Contractor City of Ft Collins Sales Tax # Are you paying taxes here or by report? Here ❑ Report
salesraxm=bert5req&-dbranconftc m Are you paying with your trust account? Yes ❑ No
Is this a residential or oo project? Idential ❑ Commercial
If residential, Is it ngle Family Deb shed ❑ Condo/townhome (single family attached) it7'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 ormore? ❑ Yes O No If yes, you may need to contactH/stor/c Presffm#on
If this is for a demolition permit, what year was the -building constructed?
Description of work GuL l S o C4:S 1
*If lawn sprinider/bacldiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: tlsythecompany name orOtyofftCollins 11cense 0
>decbician Plumber Mechanical goofy pg1es
I hereby acknowledge that I have read this applicadon 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 valld.until it has been paid and Issued.
Applicant:
Print Name: ^� f i U r1 r�J Sign D / J
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