HomeMy WebLinkAbout1931 Ridgewood Rd - Applications/Reroof - 08/31/2017City of Planning, Development, & Transportation Services
Fort 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-strucwral) ❑ 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 ❑ WoodlPellet 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 I Date v/5l1/�
For oflce use only
Job Site Address (requued) Value of Construction (labor, materials, profit)
1931 �40'e."OA
r operty Owner Nape Address City/State Zip Phone
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Applicant Name Address City/State Zip Phone
Contra or Address City/State Zip k53-7 Phone
� 112ti C. t bit<� �ti!o 593- 340
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Contractor Ci of Ft Collins Sales Tax # Are you paying taxes here or by report? ere ❑ Report
Cl No
Sales tax number a required by all contactors Are you paying with your trust account? PYes
Is this a residential or co,mmercial prolect7 esidential ❑ Commercial
If residential, is it Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it ❑ Bank ❑ Bar ❑ Church ❑ Motel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No /f yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description1 of work G yi Li
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*If lawn sprinkler/backflow preventer, must list licensed plumber If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of ft Collins license k
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: <<'���,, /3I
Pnnt Name- J0.� 1/pn i, % Signature Date
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