HomeMy WebLinkAbout942 Driftwood Dr - Applications/Reroof - 11/15/2012City Of Planning, Development & Transportation
Fort Collins For N. College Ave P.O. Box 580
Fort Collins,
CO 80524
Phone 970-41616-27402740 Fax 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 se ce change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacer se
❑ 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.
Application # P_> n )- 0
For office use only
Incomplete applications will not be accepted.
Date
Job Site Address (required) Value of Construction (labor, materials, profit)
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Property Owner Name Address
City/State
Zip
Phone
Applicant Name Address
City/State
Zip
Phone
Contractor Lic # Address
City/State
Zip
Phone
1i ana ¢- 1
Contractor City of Ft. C ns 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? residential ❑ Commercial
If residential, is it: eEr5ingle 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 ❑ No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
if prior to 1975, you will need an asbestos assessment to submit with this application.
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontr ctors• LI Sr �U7ee rc pany name or City of Ft Collins license #
ElectriciaFe W " 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.
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Applicant: f7 r- S g
Print Name: rQn N row �, F� Si nature Date