HomeMy WebLinkAbout2130 Ryeland Ln - Applications/Reroof - 05/04/2018i
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City of
Coltins
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Planning, Development & Transportation
281 N. College Ave P.O. Box 580
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 i 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 # )6Icob 31 Oa Date
For office use only
Job Site A dre s (regyired)
Value of Construction (labor, materials, profit)
2i30 n``1-n Dorf C'o(I�ns
Co -4 t 3C(5.on
Property Owner Name Address
City/State Zip Phone
2l3a fZ lar\ci
1,n. For+CoIIin5 Co goS2.b 4700 73
Applicant Name Address
City/State Zip Phone
Ursa lArvie kO Io3o 2cs�-on AJG Lo v.1or\t Co 80Sot -1, o-bect-55Oo
Contractor Address
City/State Zip Phone
GreenPokn-1- RooFi Same- as a.Fp1'rcan-t"
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here ❑ Report
Sa,estax numberisrequiredbyall contractors.
Are you Paying with your trust account? ❑ Yes ❑ No
Corrtr•an►-or Gcente, R-?a-I59_
Is this a residential or commercial project? N Residential ❑ Commercial gtbVJ
If residential, is it: � Single Family Detached ❑ Condo/townhome (single family attachd) ❑ 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?
L`prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work -fear err 6,sVi ng% rooF lro dec1__(I S SQL ',nSt 4w4,etie. Pe,i4-
Gri !'Lai'el t
n rnir,a-f TvF DrrreA- uv+ rw, A STI InynK't- rt5ist�A.'A - 611 .,AICS r fe-Hall c
*If laa sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list icense'd electrician.
Subcontractors: List the company name or City of Ft Collins license >r
Electrician Plumber Mechanical RooferOther
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: Q _ ' 1 4 ��
Print Name: 1.-�Sa- �,l.r�PY1h l (j Signature 'o'l.(JY.1- UM. Date