HomeMy WebLinkAbout3024 Ross Dr - Applications/Reroof - 07/18/2014City Of Planning, Development & Transportation
281 N. College Ave P.O. Box 580
6rr1 } ` Collins 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 ARoofing ❑ 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.
Application # I'�� 4G0
For ofAce use only
Incomplete applications will not be accepted.
Date -:�l : 18 . Jq
Sob Site Address (required) Value of Construction (labor, materials, profit)
Property Owner Name Address
City/State Zip
Phone
o
L_ c 8EQ5 3
�o 24
Applicant Name Address
City/State Zip
Phone
Contractor Lic # Address
City/State Zip
Phone OI-10
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ZZq -IZ-00
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here
J4 Report
saiestax number isrequiredbyall contractors.
Are you paying with your trust account? g Yes
❑ No
Is this a residential or commercial project? 99'Residential ❑ Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
i &ultifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
Is this
If this
❑ Restaurant ❑ Other (explain)
building 50 years of age or more? ❑ Yes ❑ No If yes, you may need to contact Historic Preservation
s for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application. I CL_ A
Description of work
• v v �--IE J I I rl V-e<,--
*If lawn sprinkler/backflow preventer; must list licensed plumber. If first-time A/C, must list licensed el ctridan.
Subcontractors: List the company name or City of Ft Collins license #, fhet cs
Electrician 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: !y L, -( . � ` � � • � �Y
Print Name: Signature Date
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