HomeMy WebLinkAbout3000 Ross Dr - Applications/Reroof - 06/01/2018 (9)FoI V "" Planning, Development, & Transportation Services
rt 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 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 information the application. Incomplete applications will not be accepted.
Application # Nco ( "1 � 1 q Date
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
6 -Gl 't�m
Property Owner Name Address City/State Zip Phone
0?9m' 3o:)`i
LJjhAW
Applicant Name Address City/State Tip Phone
P-:ni C, L a r LX,615 90W3 6 -13a0
Contractor Address City/State Zip Phone
i r ; .. ' e-QrV40 d� 3-620 - i3on
Contractor City of Ft Collins Sales Tax # Are you paying taxes here or by report? %Here ❑ Report
Sales mrnumber is zgi�re��dbyall mntradots Are you paying with your trust account? D es �No
-� U�� — !
Is this a residential or commercial project? [Residential ❑ Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
i[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 Presemabon
If this is for a demolition permit, what year was the building constructed?
Description of work l S (nc—
A H ►4r) .L„A 1F c mot; t' i het e a 'a
*If lawn sprinkler/baddlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City offt Collins license #
Electrician Plumber Mechanical Roofer j�1��jV� fQ Qa er
I hereby acknowledge that I have read this application and state that the above information is complebeeaand � 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.
Print Name:Gr Gt Z Signature Date / �+
RevWm date 7l62017