HomeMy WebLinkAbout1418 Hiwan Ct - Applications/Reroof - 10/24/2018I1-
City of Planning, Development, & Transportation Services
F6rt 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 servi change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement VRoofing ❑ 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 # z k z�) I a 3"A
For ofce use only
Date
lob Site Address (required) Value of Construction (labor, materials, profit)
Property Owner Name Address City/State Zip Phone
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W%,,l(� �,/ �b�iy� r4lp t� / ran L/,Tq -2 V7
Applicant Name —/%3-19 Address City/State Zip Phone
Contractor Address City/State Zip Phone
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here i-ICei rt
Sales tax number is required by al/ronbactom Are you paying with your trust account? ❑ Yes
Is this a residential or co ercial project? 3, esidential ❑ 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 If yes, you mayneed to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work ec 1�' 1&&O su✓E- e '�e3✓
Y' %.09- -7
*If lawns nkler/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 # -
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� �j
Print Name: / �4/��Gl/ �i� Signature tit/ Gt✓��� Date
Revision date 2J6I2017