HomeMy WebLinkAbout904 Ponderosa Dr - Applications/Reroof - 08/31/2017City of Planning, Development, & Transportation Services
F6rt Collins Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main 970 416 2740 Fax 970 224 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 tove (must be EPA certified, provide make, model and
manufacturer)
Complete all applicable information on the application. Incomplete applications will not be accepted
Application # 2176 0'10 Date 9-3/' 1-7
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
g:�i G'o
Property Owner Name Address City/State Zip Phone
Applicant/Name Lor Address City/State Zip Phone
Contractor Address City/State Zip Phone
Contractor City of Ft. CoilKs Sales Tax # Are you paying taxes here or by report? ❑ Here ''Report
5alestax number IsrequIredbyall contractors Are you paying with your trust account? ❑ Yes �No
Is this a residential or commercial project? ,Residential ❑ Commercial
If residential, is it ❑ Single Family Detached ❑ Condo/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 Histonc Preservation
If this is for a demolition permit, what year was the building constructed?
Descrl tion of work ✓2 > %
*If lawn sprinlder/bacldldCpreventer, must list licensed plumber. If rst- me A/C, must lost licensed electrician.
Subcontractors: List the company name or Gty of Ft Collins license #
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:
Print Name �li V'""/� Signature, �` Date
Revision date 2! =17