HomeMy WebLinkAbout6212 Pheasant Ct - Applications/Reroof - 07/23/2019`Qtyof - 1 l�larr�asn Devefq f 7
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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 Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Sto
manufacturer). ve (must be EPA certified, provide make, model and
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application #y I qt) S SL9 Date _ -1 I a3 JJq
For office use only
]ob Site Address (required) Value of Construction (labor, materials, profit)
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Property Owner Name J Address City/State Zip Phone
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Applicant Name Address City/State Zip Phone
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Contractor Addr s Gty/State Zip / Phone
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Contractor City of FL Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
sales tax number Is required by allconbadors. Are you paying with your trust account? XYes ❑ No
Is this a residential or commercial project? 1$j Residential ❑ Commercial
If residential, is it: 1fi Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar El Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (ex ain)
Is this building 50 years of age or more? 'q Yes No If yes, you may need to contact histoncPreservation
If this is for a demolition permit, what year was a building constructed?
Description o wo
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*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electdclan.
Subcontractors: list the company name or Gty of Ft Collins license #
Elecbician Plumber Mechanical RooferWah "1Other
I hereby acknowledge that I have read this application and state that the above information is complete and cored I agree to
comply with ails requirements contained herein and city ordinances and state laws regulating building construction. I know that a
permit is not valid until it hasbeenpaid and Issued.
Applicant: r\S�
Print Name: lo�'�yi� Signature 9 _ _
: )(1'L1)Y \ T(.1 �i� .I /U V!__ Date 13 1
Revision date 2MR017