HomeMy WebLinkAbout3019 Lisette Ct - Applications/Reroof - 10/18/2018City of Planning, Development, & Transportation Services
,.Fort 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 ❑ 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 # �/ tILDate
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Job Site Address (requ/red) Value of Construction (labor, materials, profit) �a
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Property Owner Name Address City/State Zip Phone
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Applicant Name Address City/State Zip Phone
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Con ctor Address City/State Ap Phone
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Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? O'Here ❑ Report
saMstax manaer®dredbyall Wn&acmvs Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? O"Residentlal ❑ Commercial
If residential, is it: UrSingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, Is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building So years of age or more? ❑ Yes ❑ No If yes, you may need to contactHbtnrfc Preservation
If this is for a demolition permit, what year was the building constructed?
Descn 'on of wo
*If lawn sprinlder/backflow preventer, must list licensed plumber. If fl -time A/C, rnuA list licensed electrician.
Subcontractors: List the company name or City of Coffins fist? #
Electrician Plumber Mechanical Roder 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 /
Print Name: 1 Signature4W--AY--111 ��_
ROVISIM day ZVM17