HomeMy WebLinkAbout2904 Ringneck Dr - Applications/Reroof - 10/25/2018City of Planning, Development, & Transportation Services
Fort Collins Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main: 970A16.2740 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 oon( the application. Incomplete applications will not be accepted.
Application # III'- IL9f) Date
For ofll& use only
Job Site Address (required) Value of Construction (labor, materials, profit)
c290"7 R1N6-NGGK 6/.' FORr eeiLL/NS zo RioSZ& /6 4� Z S•ro.ey
Property Owner Name Address City/State Zip Phone
5b.?sn1 Aribe-2so,-i 79off Zoc—vrek DR F62r G'oLL, co sroSzb 970-691-38t5-
Applicant Name Address City/State Zip Phone
y34yEN$ ysp/ /ie4bamtj tr tt2ejo co.2r 634Li- j Cc 7OSJl( 920-49/-'236
Contractor Address City/State Zip Phone
6tZV4rF2 F12/_1.',7- ,eA-JGC /Sul A4AAFmy er zftod fn_r sole/—S co poszq 970 - 797-271.0
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
sales tax number isrequired byall contractom Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential o co ercial 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 HistoricPreservallon
If this is for a demolition permit, what year was the building constructed?
Description ofwork _ean4/4/Frt leaorz ro i�Eere,va /NsFczr Fo26uooA/2oi. /nrST, ze_
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nu/6^15 CoR/yl"e- &R-.4770-J 57_e,e.44 54"-'6-4E
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the companyname 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: //M /3�yE� / Date ��"Z r-/
Print Name: Signature1 �"I^�^ —
Revision date 2 92017