HomeMy WebLinkAbout2763 Saddle Creek Dr - Applications/Reroof - 02/15/2017City 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 sery 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.
Application # 6I �
For ofte use only
Incomplete applications will not be accepted.
Date
Job Site Address (required) Value of Constrron (labor, materials, profit)
2,-1 Cr 1�) v 161-0
Property Owner Name Address City/State Zip Phone
S C. oft o licf fSZ
Applicant Name Address City/State Zip Phone
Contractor ddre City/State Zip Phone 3
1 o o oP w t-e i o e-n4-ey 1 0
Contractor City of Ft. Collins Sales TU # 0 Are you paying taxes h e or by report? ere ❑ R port
Sales tax number is required by all contractors. Are you paying with your trust account? ❑ Yes llo
Is this a residential or co� mercial project? Residential ❑ Commercial
M If residential, is it: Single 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 V No 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 — o S C rt
V41 Sio 0.0
*If lawn sprinkler/backflow 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 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.
Print Na e�0*_ O'SD� Signature 1� Date
Revision date 2rd2017
39 -1111
5- 6310
)22-1