HomeMy WebLinkAbout1900 Ridgewood Rd - Applications/Reroof - 01/03/2018Cit of Planning, Development & Transportation
FY 281 N. College Ave P.O. Box 580
ort Collins Fort Collins, CO 80524
`- Phone 970-416-2740 Fax 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.
Application #�� bo1W
For ofl- e use only
Incomplete applications will not be accepted.
Date
Job Site Address (required) - J ':'. 1
' Value of Construction (labor, materials, profit)
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Property Owner Name Address
City/State `, ' ' Zip ? (; Phone 0
77
Applicant Name tio/Ua r\ cge d Address
City%Sta�c o �o r Zip 9OSSD Phone
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Contractor Address'
City/State Zip Phone
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here ❑ Report
Sales tax number is require dbyall contractors.
Are you paying with your trust account? ❑ Yes ❑ No
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Is this a residential or commercial project? I>Emesidential ❑ Commercial
If residential, is it: '. 3 ingle 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 ❑Mo If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work
*If lawn
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 #�
Electrician Plumber Mechanical Roofer othe
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: {. �� i -
Print Name:.-- i`. �l Y ` Q R. f ( Signature -. c_i . t. ^-- .! _ Date
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