HomeMy WebLinkAbout5510 Fossil Ridge Dr E - Applications/Reroof - 07/03/201307/03/2013 14:22 9704612547
C—ft-y of
FCnn'Cothns
ATLAS PAGE 01/01
Planning, Devalopnrem & Transportation
281 N: College Ave P.O. Box $8o
Fort Collins, CO 80524
Phone 970-416-2740 Fax 22+6134
OVER-THE-COUNTER PERMS ONLY
This appllcation Is to be used to apply for the following permits only (check all that apply). 0 Air Conditioning
13 De:mollfioh (intedor non-sbuctumo ❑ Elecbricai Alteration (not se ce change) 0 Gas lighter 0 Gas Log
b Heating Unit 13 Lawn Sprinkler ❑ Mobile Home replacement fWofirlg 0 Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line II Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable infor
mation on the aPPUcatian. Incomplete applications will not be accepted.
Application #@
ForaffiCe use only
Date T
Sob Site Address ftquUedJ
Value of ConstluefiW (fabor, mate Is, profit)
-Soo
Property Owner Name
Address
City/State Zip,
PAone
b-, �>s+ co' � a s
391 - yW
Applicant Name
Address
Cty/State Zip
Phone
cr-
Contractor
Address
City/State Zi
pre �` r7
Contractor City of 1 t. Collins
Tax # `I I O"Sg
Are you paying taxes here or by report? LI Here
13 Report
-W�wtaxnmofftragzoWbya#=*aam
Are you paying with your truss account? ` 'es
❑ No
Is this a residential or commercial project? -5196ntial ❑ Commercial
If residential, is it: ❑ Single Family DdacheK1 ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Muftilarnily (apartment) ❑ Garage
If commercial, is it: ❑ Sank ❑ Bar 0 Church ❑ Hotel/Motel ❑ Medical office n Office ❑ Retail
❑ Restaurant C] Other (explaln)
Is this building 50 years of age or more? ❑ Yes ❑ NO. ff)wyoVf)layncedfocmtxtH6tOfkPA5wmbbn
If this Is for a demolr"ts_'on permit, what year was the building conducted?
Ifpmor to 1975, you MY need an asNsCus asmssz- tto submit with this app A wion.
*if lam sprinkler/backffow preventer, must list licensed plumber. If first-time A/C, must
5ubtgnb'dd3DM L&the avWanymwcrC &ofRCo&wh mw#
I hereby admowledge that I have lead this application and slate. that the above n
comply wtth all requirements contained herein and city ordinances and state laws
psrmrT 6 not valid until It has been paid and issued.
Applicailb
print Name C J DC�4
Other
bn!is Complete and correct: I agree to
(g building conshvctlon. I know that a
Data