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HomeMy WebLinkAbout410 Riddle Dr - Applications/Reroof - 10/16/2017city 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-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 # e)n-o Uz-bH For office use only Date — ( Job Site Address (required) Value of Construction labor, materials, profit) � 0 1 Property Owner Name Address City/State Zip Phone AppliFant Name Address City/State Zip Phone Contractor Address City/State Zip Phone l�_o weld soS45 Contractor City of R. Collins Sales Tax # Are you paying taxes here or by report? Here ❑ Report Sales tax number isfequiredbyall mnrractors. Are you paying with your trust account? ❑ Yes ❑ No Is this a residential orcer9 mercial project? ©I�esidential ' ❑ Commercial If residential, is it: l! Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex ❑ Multifamily (apartment) ❑ Garage I S-Io 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 o2-60 • If this is for a demolition permit, what year was the building constructed? Description of work e r J "�Ak, 6u e P w. d — *If lawn sprinkler/bac ow preventer, must liselicensed plumber. If first-time A/C, must list licensed electrician. Subcontractors: List the company name or City 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: —� {( /p�/� / I Print Name: / `� �l / ' '/�C-+-, Signature 4C Date f� Y6, �� Revision date 2/6/2017