HomeMy WebLinkAbout1951 Bowsprit Dr - Applications/Reroof - 04/11/2019City of Planningf, Development, & Transportation Services
�t 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 ❑ Mobile Home replacement NdRoofing ❑ 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 # -1 S Date
For ofce use only
Job Site Address (required) Value of Construction (labor, materials, profit)
\Q►S\ d SQ c, V-0A s W \ '�) 1loS 1
Property Owner Name Address City/State Zip
Phone 511
La.,.ra ��xr.s \0-\S\ qpr� C�\� U 305'-�
a\a sgyl
Applicant Name Address City/Stater Zip
Phone
\
4, pQ.�%N. �l y0 ch Y YSrO ca W�\� nS CA 8�15r
$ -`�1 l
Contractor 1��j'��S Address City/State Zip
Phone b\R
N �\� S r►
Gas-a110
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? XHere
❑ Report
Sales tax number Isrequ/red by al/mntractom Are you paying with your trust account? ❑ Yes
�No
00 \3-� Say
Is this a residential or commercial project? )t Residential ❑ Commercial
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? ❑ YesNo If yes, you may needgtc contact Historic Preservation
If this is for a demolition permit, what year was the building constructed? nl cl�
Description of workC� c
*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# 1�1
ElectricianT_ 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.
Applicant: \\ _C�- A � ti
Print Name:�S�c..,� l�tiL\" ��� SignatureN�k \3 , 0.- Date ' W
Revision date 2/0/2017