HomeMy WebLinkAbout712 Ponderosa Dr - Applications/Reroof - 10/23/2018City of Planning, Development, & Transportation Services
F6rt 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 # 6 ( �01;)4�_ Date
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
U
msz,
Property Owner Name Address City/Stat Zip Phone
Ir
v z( 21231-i6
Applicant Name_ ddress City/State Zip Phone
Address City/State Zip �� Phone
�Con�tractoorr
/ % Op _ �/�/ C
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
Sales tax number is required by all contractors Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? Residential ❑ commercial
If residential, is it: )11 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 SO years of age or more? ❑ Yes ❑ No If yes, you mayneed to contact Historic Preservation
If this is for a demolition permit, what year was the builldiin{g! constructed?
Description of work
17o fMA A ��i1/M/Y ii1/t ! S)"L/q 14 i)Q"
��'
L�
*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 #/
l/n
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-
V ( / D
Print
Print Name: Signature Date
Revision date 21612017 L/