HomeMy WebLinkAbout1418 Indian Paintbrush Ct - Applications/Reroof - 07/13/2018F.ort<'; PAanningr DeVe®enpment, & Transportation Sen✓ red-
Coffins Community Development 8t Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main: 970.416,2740 Fax: 970.224.6•I34
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). ❑Air Conditioning
0Demolition (interior non-structural) ❑ Electrical Alteration (not service change) 0 Gas Lighter ❑ Gas Log
❑ Heating Unit O Lawn Sprinkler Ci Mobile Home replacement X Roofing ❑ Sewer Line ❑ Photo -voltaic
IJ Ventilation ❑ Water Heater Cl Water Line 0 Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
complete all appl' le i ormati on the application.
Application
For o rice use only
Incomplete alapiications will not be accepted.
Date 7/1 �1/�
J(®fib Site Address (required) / Vague of Construction (labor, materials, profit) y
I { • )u Y��l � (,iS�--L.� . ✓; l Coll i � i � � �% 9 S M, k ' -C) Jc-' 1 11)Lf 1/.
Property Owner Name Address City/State Zip Phone
I ac� 1{irlSlsr✓nq IS13 �'�-S�v;t� Aw - Ali ("Iii. 1 176 )J z 19�Q
Applicant Name Address City/State Zip Phone
Contractor Address
/City/State "Lip Phone
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Sales tax number is required by all contractors. Are you paying with your trust account? O Yes 011
Is this a residential or commercial project? Residential ❑ Commercial �!T
If residential, is it: CKSingle Family Detachett ❑ Condo/townhome (single family attached) 0 Duplex
CI Multifamily (apartment) Ci Garage
If commercial, is it: 0 Bank ❑ Bar ® Church 11 Hotel/Motel 0 Medical office 0 Office U Retail
0 Restaurant 0 Other (explain)
Is this building S® Vears of age or more? 0 ;Yes ❑ No ff ye you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work '&', ,rk txr i
y^nl'Cp;J,cc
*If lawn sprinider/backFlow preventer, must list licensed plumber. If first-time A/C, n•Qu Iigp gicensed electrician. � -�—
Subcontractors: List the company name or Cil y of Ft Collins license
Electrician__ _ Plumber_ Mechanical.._,_•___—_ Roofer Lu116z
Other -_-�- -
L 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. a Im aw that a
permit is not valid until It has been paid and Issued.
Applicant: (� Print Name:- 1� u x (C to --
1 a n, (1 -- sFpnacar® l�/�• -� ; ��� /�✓" 7/i 7
�. Date _ 3 /
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