HomeMy WebLinkAbout1833 Brightwater Dr - Applications/Reroof - 06/11/2019city 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 P--) Nu
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 serve/pe change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement [3 Roofing ❑ Sewer Line ❑ Photo -voltaic
LiVentilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable informationonthe application.
Application # G 1 q O `i � Vl
G,, nM m „cG nnly
Incomplete applications will not be accepted.
Date
Job Site Address (required) Value of Construction (labor, materials, profit)
33 1 (, I A-f (P 'E�o
Property Owner Name Address City/State Zip Phone
W3 10, wv fl(- co 805C�d-19 236
Applicant Name Address City/State Zip Phone
I r, (-1, \rJ ; l a� D� t 4 r �,(c f a 1 9Sa S y -UY-3 pro
Contractor J
n Address City/State Zip Phone
J ROD
Contractor City of Ft. Collin Sales Tax Are you paying taxes here or by report? ❑ Here " ❑ 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? ETResidential ❑ 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? ❑ Yes ❑ No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Des rjptiol of work - (o o 4 i � � 2- c11 Y
*If law4nn sprinkler/backnow 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 Roofed b 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. I
Applicant: �1 (� h l pate -
Print Name: I J ^ � % l Signature _� '
Revision date 202017