HomeMy WebLinkAbout3915 Ridgeway Ct - Applications/Reroof - 09/09/201109/08/2011 11:34 9703305645 SLAUGHTER ROOFING PAGE 04/05
City of
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
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 CI Sewer Line ❑ Photo -voltaic
❑ Ventilation D 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 # ' �/ ' ��s3i? Sid' Date
For ofAce use only
Job Site Address (requ/redj
Value of Construction (labor, materials, profit)
00
Proerty Owner Name Address
City/State Zip
Phone
p` TL
5
Applicant Name Address
City/state Zip
Phone
1 G 20
I
Contractor Address
city/state Zip
Phone
21W C o
o
Contractor City of Ft., Collins Sales Tax #
Are you paying taxes here or by report?
X Here ❑ Report
Saie�tax nuumberarequneabYamm0aacrors.
Are you paying with your trust account?
(il Yes 0 No
Is this a residential or commercial project? $] Residential ❑ Commercial
If residential, is It: 0& Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex -
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel A Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building So years of age or more? ❑ Yes fJ No Dyes, you may need to contact HistoricPtesevation
If this is for a demolition permit, what year was the building constructed?
ffpnor to 1975, you W11 need an asbesins assessment to submit with this application.
n nn er/backRow preventer, must list licensed plumber. It First-time A/C, must list licensed electrician.
Subcontractors: List the company name or Cty of Ft Collins license ,#
Oeclridan 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: /�
Print Name: l /PtRk ( I,A1X9k)jP. Signature Z�f Date