HomeMy WebLinkAbout3005 Ross Dr - Applications/Reroof - 06/04/2018 (8)• Vr i VVilrr IJ
----�, _ 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 XRoofing ❑ 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 #S.1j Date (o• 4 • 1� —_
For office use only
lob Site Address (mqufied) Value of Construction (labor, materials, profit)
3�5 s RO& w -3S _V 0. �I-
Property Owner Name Address Gty/State Zip Phone
aqoe-3Lw..?ti
-s or 601ing 0 �aSa6 20 6& --2"
Applicant Name Address city/Ste Tip Phone
R, 4 6, t. a 6b 1610 -1300
Contractor Address City/State Tip Phone
Contracnr City of FL Collins Sales Tax # Are you paying taxes here or by report? kHere ❑ Report
salesnwnbw Is .a'byancw,o-acars Are you paying with your trust account? ❑Yes )�10No
Is residentialthis �a=' or commercial project? P(Residential ❑ Commercial
If residential, is it ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
1K Muttifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank. ❑ Bar ❑ Church ❑ HoW/Motel ❑ Medical office ❑ office ❑ Rail
❑ Restaurant ❑ Other (explain)
Is this building So years of age or more? ❑ Yes )(No If yes, you may need to cantact ffzft* Preservation
If this is for a demolition permit, what year was the building constructed?
ption of work'"`
A O
*If lawn sprinkkw/baddiow pre enter, must list licensed plumbers if first-time Alc must list licensed electrician.
Subcontractors: List thecompmyname orCity offtCohrinsficense ` r
Electrician Medmid \ Roofer -lov"�
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 requirernen 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.
Appl
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Print Name: tT G1 Z 5rgn�m / D,1
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