HomeMy WebLinkAbout3000 Ross Dr - Applications/Reroof - 06/01/2018 (11)Uommunity Uevelopment & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main: 970.416.2740 Fax: 970.224.6134
OVER-THE-COUNTER PEkMi i b
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 IXRoofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable infonanthe application.
Application 1
For offce use only
Incomplete applications will not a ccepted.
Date J
)ob Site Address (required) Value of Construction (labor, materials, profit)
Qom QA B D -a 4556
Property Owner Name Address City/State Zip Phone
-29oc 30jci
Applicant Name Address City/State Zip Phone
&C,,c. e (_o golo 3 e •1300
Contractor Address City/State Zip Phone
033 �, e (0 05S 3 �Sn2c -i3oo
Contractor City of R. Collins Sales Tax # Are you paying taxes here or by report? P,�Here ❑ Report
Sa/rstaznumber is uiradayammnbactors Are you paying with your mist account? ❑fi�rres j@'No
_M \ C3
Is this a residential or commercial project? Pkilesidential ❑ Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
V[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 contactHi5Yolic Preservabion
If this is for a demolition permit, what year was the building constructed?
Description of work cx S 55 $�z (n _ 2QRQ_
sl -
*If lawn sprinkler/baddiow preventer, must list licensed plumber: If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of it Collins license #
Electrician Plumber Mechanical RooferN�?Wk her
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:
Print Name: BC-67 Z Signature Date
RevNon data 2=2017