HomeMy WebLinkAbout4136 Snow Ridge Cir - Applications/Reroof - 10/17/2014City of
F6rit Collins
111'
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 ❑ 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.
Application # $I:!j-10 320 Date
For office use only
]cab Site Address (required)
Value of Construction (labor, materials, profit)
3(04 43+— StAo w
'-id e Ci ml e
I (v s
Property Owner Name
Address City/State Zip
Phone
2 h —Ycv\
Applicant Name
Address City/State Zip
Phone
lutw PGR{ t—
Z>S o'cc�5 C7'7 CD g-0537
1770-310-3` J3,;?
Contractor
Address City/State Zip
Phone
l X-"t
l4 5�L vv2.
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report?
a ere ❑ Report
Wes taznumberisrequimdbyall Contractors. Are you paying with your trust account?
RrYes ❑ No
Is this a residential or commercial project? ETResidential ❑ Commercial
If residential, is it: QSingle Family Detached ❑ Cando/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
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 No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Ifpr/or to 1975, you wi// need an asbestos assessment to submit with this application.
of work
*If lawn sprinkler/baddlow preventer, must list licensed plumber. If first-time A/C, must list licensed eledridan.
Subcontractors: List the companynameorGtyofFtCollins license# (5un 9,
Electrician Plumber Mechanical Roofer Q-ltot6 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: _ n ' f1 ! '7 �"
Print Name: WGid 1�e,� � Signature G _ Date 1 T