HomeMy WebLinkAbout4274 Stoneridge Dr - Applications/Reroof - 10/15/2014City of
� rt Collins
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 se ce 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 # T?> I A4 01A15T Date (O� l��y
For ofte um only
Job Site Address (required)
Construction gabor, materials, profit)
L Q l
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ca ll � C—G
erty Owner Name
Address
City/State Zip
Phone
e S
P t- r+ c_ co
Applicant Name
Address
City/Si9te Zip
Phone
Contractor
Address
city/state Zi
hone 4-77�
G-154
w. �"'� a�� co
Contractor city of Ft. Collins
Tax #
Are you paying taxes here or by report? ICHIVre ❑ Report
salestax number&requiredbyaiimnftacmm
Are you paying with your trust account?
❑ No
Is this a residential or noal project? � Rtsidential ❑ Commercial
If residential, is it: ❑ ing Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ ultifamily (apartnent) ❑ 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 Ifyes, you may need to contacmistoricpreservatlon
If this is for a demolition permit, what year was the building constructed?
Ifpnor to 1975, you wi/l need an asbestos assessment to submit with Hris application.
Description of work KPM of 12
*If lawn sprinkler/baddiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Listd7e company name orCity offtCollins Acertse #
Electrician Plumber Mechanical Roofer Other
I hereby acknowledge that I have read this application and state that the above information is complete and omtct 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.
PrintNme: C�J 1C1X3��� Signature Data V