HomeMy WebLinkAbout968 Campfire Dr - Applications/Reroof - 07/16/2018City 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 servicechange) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement oofing ❑ 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 #?)N1b"5s7!61 Date % • I 0
For ofce use only
Job Site Address (required Value of Construction (labor, materials, profit)
CM U o D
Property Owner Name Address City/State Zip Phone
) q
f 10 CG�M 4t Cc T ED4coI� &S tl (/ iQ L lbc yq- o
fl
Aunt Name Address City/State Zip Phone
I^ �, a IOk(A d f C �C) �O- 38&•-3Yo�
Contractor Address City/State Zip Phone
rWd17
G
Contractor City of Ft. &llins Sale Tax # Are you paying taxes here or by report? C:1'Mere ❑Report
Sales tax number is required by all contractors. Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? ET Residential ❑ Commercial
If residential, is it: C"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 ❑-IGo 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
a[ roo
I Sc45r
S
*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 Roofe[. R°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:' I 1 I
��
Print Name: `' * �N Signature` Date
Revision date 2/6/2017