HomeMy WebLinkAbout6207 Eagle Ridge Ct - Applications/Reroof - 09/30/2011.ti
City of fort Collins Building and Zoning Dept. P.O. Box 580 Fort Collins, CO 80522
4 Phone U 221-6760 Fax 970-224-6134
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City of Foet �11 � OVERmTHROUNTER PERMITS. ONLY
Use this application to apply for a permit`for any of the following: (check all that apply) ❑ air conditioning, ❑ demolition
(interior non-structural), ❑ electrical alteration (not service change), ❑ gas lighter, ❑ gas line, ❑ gas log, ❑ heating unit,
❑ lawn sprinkler, ❑ mobile home replacement, roofing, ❑ sewer line, ❑ ventilation, ❑ water heater, ❑ water line,
❑ wood stove (*provide model name & number).
Complete all areas of the applications that are applicable to your permit request - Incomplete applications will not be
accepted. An over-the-counter permit will only be valid when it has been paid -in -full and issued.
Application #
Date
(for office unse onlly) ?110
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1
Owner Na a Address z1P Phone
;Property
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Applicant Name Address g, Phone
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Contractor Name{{ QS City Uc # R /mod Address Phone 14�Z 73zx
Contractor City of Ft. Collins sales tax Pay taxes here? ❑ Yes ❑ No
Job Site Address
Value of Construction (labor, material, profit)
3 )�
6
Is this a residential oject? Yes ❑ No
If residential is it: - Single family detached ❑ Condo/Townhome (single family attached)) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
Is this a commercial project? ❑ Yes ❑ No
If commercial is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical Office ❑ Office ❑ Retail
❑ Restaurant ❑ Other(explain)
Is this building 50 years of age or more? ❑ Yes (tK[ No
If yes, you may need to get historic preservation approval prior to permit issuance.
Description of Work -c Slit& � St%i n f'( (tS a.
io�S fn� 1 1 w as (rta(f
**If lawn sprinkler/backflow preventer installation, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: (list the contractor company name or license #)
Electrical Mechanical Plumbing Roofing Other
I hereby acknowledge that I have read this application and state that the above information is correct and agree to comply with all
requirements contained herein and city ordinances and state laws regulating building construction.
Applicant:
Print Name Signature Date