HomeMy WebLinkAbout2213 Rambouillet Dr - Applications/Reroof - 11/02/2017FCiiyOf Planning, Development, & Transportation Services
ort 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.
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Application #�,%V I _ ( Date
ForFor office use only
Job Site Address (required) ,. Via e of Construction (labor, materials, profit)-7 -is
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Property Owner Name Address City/State Zip Phone
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applicant Name Address City/State Zip Phone
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Contractor �y Address City/State Zip Phone
Contractor City of Ft. Collins Sales Tax #t] Are you paying taxes here or by report? 1� Here ❑ Report
Sales tax number isrequiredbyall contractors . Are you paying with your trust account? ❑ Yes 9No
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 Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work
Ag0l1n�7"Ciu24 SIYING[
*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 # .F X� 5 /1Z ,�
Electrician Plumber Mechanical Roofer ,� D t1 rnJh 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. f
Applicant:
Print Name: 01R�_a S �Y-41rkk Signature Date j •`� i
Revision date 2r2017