HomeMy WebLinkAbout1425 Indian Paintbrush Ct - Applications/Reroof - 10/01/2018ct Plar,'TingT, Development, & Transportation Services
,Fort Collins Community Development & Neighborhood Services
xf �� 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 servicechange) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement I�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 #_ e)V60�st's Date
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
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Property Owner Name Address City/State Zip Phone
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Applicant Nam Address City/State Zip Phone
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Contractor Address City/State Zip 2� Phone
Contractor City of Ft. Collins es Tax #Are you paying taxes here or by report? ❑ Here ❑sales
tax number is requiredbyallconbactmrs. Are you paying with your trust account? ❑ Yes ❑
jNo
Is this a residential or ccom ercial project? esidential ❑ Commercial
If residential, is it: 11r. ingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail S+DY j
ElRestaurant CI Other (explai 1
Is this building 50 years of age or more? ❑Yes o 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
4 � ^ ' � C F
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*If lawn sprinkler/baddlow 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 D kQQfif) IOther
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: l L Signature - Date f 0 1
Revision dale 2/6/2017 V �,/