HomeMy WebLinkAbout636 Cheyenne Dr - Applications/Reroof - 03/27/2017FCCiityof Planning, Development, & Transportation Services
'rt 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 ❑ Mobilp 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 #
For office use only
Date 3107117
1
Job Site Address (required) Value of Construction (labor, materials, profit)
36, Che erne Dr, 'afS_M.
Property Owner Name Address ,p City/State Zip Phonej/�
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Applicant Name Address City/State Zip Phone
41 Sdr C-a
Contractor Address City/State Zip Phone
/p/ /�Ph>iM'
Contractor City of R. Collins Sales Tax # Are you paying taxes here or by report? ere ❑ Report
Sales tax number is required by allcon&actors. Are you paying with your trust account? ❑ Yes )RLNo
Is this a residential or commercial project? X6sidential ❑ Commercial
If residential, is it: ❑ Single Family Detached ndo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (ep In)
Is this building 50 years of age or more? ❑ Yes;2No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Descri tion of work - f c la s s 4 di `rr7 en s/ ve7q SLi % �5
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*If lawn sprink er/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-Z;71^f/ 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: i'1'1 r'l///IG' Signatu Date �� / 7
Revision date 2rW2017