HomeMy WebLinkAbout419 Riddle Dr - Applications/Reroof - 01/17/2013Planning, Development & Transportation
City/}of 281 N. College Ave P.O. Box 580
FOr Collins Fort Collins, CO 80524
`- Phone 970-416-2740 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 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 Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # Date
For office use only
Job Si e A dress (requ"re) Value of Construction (labor, materials, profit ��
Prope Owner Name Address City/State
Zip qone
ApplicaaLName— Address
City State
Zi Phone
/I
4
ntr qor Li Address
City/S to
Zip Phone
Contractor City of Ft. Collin ales Tax #
Are you paying taxes here or by report? ❑ Here Report
Sales tax number is required by all conbactors
Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or co mercial project? Residential ❑commercial
If residential, is it: ngle 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 So 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.
Description of work
*If lawn sprinkler/backflow p(eventer, must list licensed plumber. If first-time A/C; must list licensed electrician.
Subcontractors: List the company name or Gty of Ft Collins license #
Electrician Plumber Mechanical Roofer As%(__5� 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:
Print Name: / Sign rer / Date