HomeMy WebLinkAbout2601 Riverbend Ct - Applications/Reroof - 10/17/2011t
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FCiort Collins
To:2246134 ;9705931119 # 2/ 4
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 g 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.
00
Application # Date % 7 ! i
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
,2 01 I<Wey-bend Gf.
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Property Owner Name Address
City/State Zip • Phone
nW Re,bolds Cc' . I 1 CO 5 do kf
� F-f C011 i nS CQ '30 5:25 970--56C-302
Applicant Name I Address
City/State Zip Phone
Se�r 1,07Z-CK 695 4 Loc. Avr- 1,oVe,(.l. CO a0529 70--60-9100
Contractor Address
City/State Zip Phone
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? Here ❑Report
Salo tmnumber Isrequired byall confractax
Are you paying with your trust account? ❑ Yes KNo
Is this a residential or commercial project? ❑ Residential 'Commercial
If residential, is it: ❑ Single Family Detached 0 Condo/townh6me (single famly attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office 9office 0 Retail
❑ Restaurant ❑ Other (explain)
Is this building SO years of age or more? O Yes O No If yes, you may need to contact Historic Presen. ration
If this is for a demoridon permit, what year was the building constructed?
Ypnor to 1975, you will need an asbestos assessment to submit with this application.
Description of work A-nr014 Itia re-s cA ro L A5f 1n t en17o ra rL
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*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List Me company name or City of Ft Collin license # 2
Eledrldan Plumber Mechanical Roofer i l 3 Other
I hereby acknowledge that 1 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 {�1'IS�1`ln./v`C/r�lyl�i)1 Si Date /0//
Print Name: / � gnature