HomeMy WebLinkAbout500 Riva Ridge Dr - Applications/Reroof - 08/27/2014Planning, Development & Transportation
city of I 281 N. College Ave P.O. Box 580
F6r't CoWns 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 hoofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer). `\ O
Complete all applicable information on the application. Incomplete applications will not be accepted. 1
Application # 131'4070®a Date $ a7"l4
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
Property Owner Name
Address
City/State
Zip
Phone
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11
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g 1- 0 $i
Applicant Name
Address
City/State
Zip
Phone
AkE,
Contractor
Address
City/State
Zip
Phone
It�t 3rwG Ii0^-�
27 5 s, .S�IV=�nE 5i � �c1t10
80/�l
310 6 - �3 '1
Contractor City of Ft. Collins Sales Tax #
sales tax number is required by all con6actors
Are you paying with your trust account?
❑ Yes �o
Is this a residential or corpmerdal project? O'K�idential ❑Commercial
if residential, is it: IZI Single Family Detached ❑ Condo/townhome (single family attached)
❑ Multifamily (apartment) ❑ Garage
If commercial is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office
❑ Duplex
❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No If yes, you may need to contactH/storic Preservation
If this is 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.
Description of work
*If lawn sprinkler/baddiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: /Ist the company name or City of Ft Collins license #
Electrician Plumber Mechanical Roofer Te-e' 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
Print Name:#11te Signature
Date 8-27—/