HomeMy WebLinkAbout2804 Ringneck Dr - Applications/Reroof - 10/10/2017F'' � : Planning, Development, & Transportation Services
6r# Collins Community Development & Neighborhood .lverdiCP_S
.81 Ncrth College Avenue
Fort Collins. CO 80524 Main: 970.416.2740 Fax: 9-0.224.6134
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 I Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation 0 Water Healer ❑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 #—b
For office use only
Date_--. 1 O 1 10 l
lob Site Ad ress (requi ed) Value of Construction (labor materials, profit)
Property Owner Name Address City/State ip Phone
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( -�'' i lat, L) / C O z S,'i�
Applicant Name Address City/State Zip Phone
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Contracttor^
n— % Address /J City/Stated Zip Phone
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Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here O Report
Saies tax number is requires by all contracra-s. Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? ❑ Residential ❑ Commercial (I
If residential, is it: Q(Single Family Detached ❑ rondo/townhome (single family attached) 11 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?
Description of work ;:�be r.
"e.' ,tee. v--_lx�� n %� •,l� >�
*If lawn sprinkler/backRow 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 #
clectndan Plumber Mechanical. Roofer _LLN �11_ Other
I hereby acknowledge that I have read this application and state tha Bove information is complete and correct. I agree to
comply with all requirements contained herein and city ordinances nd sta e I s regulating building construction. I know
that a
permit is not valid until it has been paid and issued.
Applicant:
Print Name:ls'�__ �n �1 Signature Date /�Z12
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