HomeMy WebLinkAbout6915 Ranger Dr - Applications/Reroof - 09/26/2011Sep 26 2011 8:22AM HP LRSERJET PAX .5
manning, Development Olt Transportation
261 N. College Ave P.O. Box SOO
Collins Fort Collins, CO 80S24
Phone 970-416-2740 Fact 22+6134
OVER-TNFrCOUNTER PERMITS ONLY
This applkwtlon is to be used to apply for the fhvowing permits only (check sill that apply). 0 Air Conditioning
0 Oemoiltion (interior non-structural [3 Ehm Meal Alteration (not asrrvlcange) D Gas lighter 0 Gas Log
0 Heating Unn 0 Lawn Sprinkler O Mobile Home replacerner t V1400fing 0 Sewer Line 0 Photo-voftc
0 Venblelon 0 Water Heater 0 Water Line O WoodlPellet Stove (must be EPA oerdfied, provide make, model and
manufacturer).
Compiels all applicabl Infmmo ion o spolieraden. Incomplete applications will not be accepted.
APPOWtlen ... . Date
�t -
Job flubs Addrm (mw~) Value of Construction tabor, malart* proM
Property Owner Name
h. n
Applicant Name
Contractor Uc # U
Contractor City of Ft. Collins Sales Tax �
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Address - City/State :ZIP ) Phone
I
Address City/state IIp Phone
Address City/State Zip Phone
Are you paying taxes here or by report? M Here G Report
Are you paying with your trust acoount7 DIGS I11PNo
Is this a residential or co nordal project? Mrkeddentlel G Commercial
if rasiderWal, Is k: O'Single Family DetKtmd C1 Condo/bownhome (single family ate) E3 Duplex
0 Mul!lfamily (apart rent) C1 Garage
if commercial, Is tI: D Bank Q Bar D Church 0 Notelfttel, C3 Medical office 0 Office C] Retail
17 ReBstirent O 00w (explain)
Is this building 50 yaw of age or more? 17 Yes t] No ff yW Nau n ay need m e*0&W H4fir P1MAQWn
if this Is for a damolidou pernft what year was the triJilding constructed?
jrprW to J97S, yva w!V need an iss 4 as 9c Le azeanwt to submit- wO V* 4lg7Ni"a4bm
Description of work 6a =r'Q6f 3 0 Mo W+1-0 -rlr A tv k" I I LQ 1=!P N W VE, _
*If lawn sprinftlWalow proventer, rust list Ilcensed plumber. U BrsKme A/C, must list Ilcennd decoriclan,
SuroorAmtonc- I& des afl*WY name Or 0& OfFt Cats he WW 0
EkMeun = Pltsnber Mec MkW - ftQW - Other
i hereby adamlatip that 1 have need this application and state that the above Information is Complete end cared. i agree to
==ply Wth all requirements contained herein and dty ordinances and stage laws regulating bullding construction, i know that s
permit Is not valid until It has bean pstd end Isswd.
APrrintt Nam.: Ef.6A l G rye,-e )_ menst urs