HomeMy WebLinkAbout920 HAZEL CT - APPLICATIONS - 8/31/2018Aug 30 18 10:58a Severe Weather Roofing 9702233383 p.2
�City of Plal.,ling, Development, $ Transptodation services
I ,. Colons 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 ❑ Roofing ❑ Sewer Line ❑ Photo- voltaic
❑ Ventilation ❑ Water -Heater O 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 #_ 9) g 0 -4391
For office use only
Date.
b Site Address (required) Value of Construction (labor, materials, profit)
Property Owner Name Address City/State Zip Phone
-' PA
Applicant Name Address City/State Zip Phone
I
Contractor Address City/State Zip Phone
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
�45 reWfed by a//COn&acrem Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? ❑ 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 50 years of age or more? ❑ Yes ❑ No Ff yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work
l
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrkiar6
Subcontractors: List the company name or City of Ft Collars license #
Electrician 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: J
Print Name: h8ty t `'
Date
Signature :�4 --------- — J
Rwisun dale 2A6.02M7