HomeMy WebLinkAbout1208 Gaelic Pl - Applications/Reroof - 10/01/2018City of "ling, Development., & Transportation Services
Fort Collins Community Development & Neighborhood Services
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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 li' oofing ❑ 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 01b0 (tS 9 c)
For office use only
Date _ 10.1 Its
Job Site Address (required) Value of Construction (labor, materials, profit)
U� 000
Property Owner Name Address City/State Zip Phone
Yl S �lVl�1 (,�I 208 UC P1 �10-310— 15H
Applicant Nam Address City/State Zip Phone
BQ_ 5?-rlt i� MoibeSf i-�2 ,C�llcrt o z
Contractor Address
City/State Zip Phone
-Z57-
Contractor City of Ft. Collins es Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
Sales tax number isrequired byall contracrors. Are you paying with your trust account? ❑ Yes . ❑ No
Is this a residential or commercial project? Piesidential ❑ Commercial
If residential, is it: mingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retaily,/I
❑ Restaurant ❑ Other (explai ")
Is this building SO years of age or more? ❑ Yes f'No ifyes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work
0
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the companynameorCity ofFtCollinslicense
#
Electrician Plumber Mechanical Roofer 11 YL{ 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: ���
Print Name: Signature Date Q 1�
Revision date 2f62017 V