HomeMy WebLinkAbout1215 Lakecrest Ct - Applications/Reroof - 07/11/2018la r )
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CTyOf Planning, Development, & Transportation Services
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�Community Development 8 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). G Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement 5C Roofing ❑ Sewer Line ❑ ) aiiodel and
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make
manufacturer).
Complete all applicable information on the application. incomplete applications will not be accepted.
Application # )1 "� 5LVA4 Date
For o/fire use only
Job Site Address (required)
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property Owner Name
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Applicant Name
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Address
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Address
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Contractor Address
Value of Construction (labor, materials, profit)
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city/state Zip Phone
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City/State Zip Phone
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city/State Zip
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Phone
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Contractor City of Pt. Collins Sales Tax # Are you paying taxes here or y po
Saes px numbs is required by aN rontraciws
Are you paying with your trust account? ❑ Yes
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Is this a residential or commercial project? E9 Residential ❑ Commercial
If residential, is R: Lg 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? ❑ Yeses No If yes, yrou mayneed to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
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Description of work _klVi'1ovC 6 `I s
211 sa, of COirlii^ram
❑ Report
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To
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or Ory of Fr Col/ins license x
Hecvidan Plumber mechanical Roofer Other nFxtfiir
I hereby acknowledge that I have read this application and state that the above information is complete and correct. I agree to
oomply wi& all requirements contained herein anc city ordinances and state laws regulating building construction. I know that a
pernit is not valid until it has been paid and issued.
Applicant: ( i i i_•.11 `Ji'L��
Print Name: Signature
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Date 7-Il'IY