HomeMy WebLinkAbout2812 Brookwood Dr - Applications/Reroof - 03/29/2018FCity of Planning, Development, & Transportation Services
�ort 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 �aq
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 t7pftofing ❑ 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 # Date S - 21 -
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
Property Owner 4ame Address City/State Zip Phone
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Applicant Name U Address City/State Zip Phone
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Contractor Address City/State u Zip Phone
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Contractor City of Ft. Colling Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
sales tax number is required by allcontracinrs Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? MResidential ❑ Commercial
If residential, is it: T' 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 50 years of age or more? ❑ Yes ❑ 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
GLAI
*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 _9_3 9 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.
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Applicant:
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PrintName: �� I ������ Signature Date
Revision date 2162017