HomeMy WebLinkAbout3024 Ross Dr - Applications/Reroof - 06/26/2018 (7)2j
Fo�` 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 XRoofing 0 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 o/n, the application Incomplete applications mill not be accepted
f2_0464Application # y Date
For ofte ise only
lob Site Address (required) 22 �J Value of Construction (labor, materials, profit)
Property Owner Name Address City/State Tip Phone
a?9co W i
c £) C. i co e%s 0 'Fos)
Applicant Name Address City/State Zip Phone
c, C1. e- 6b SDI o 6 -1300
Contractor Address City/State Zip Phone
A r- a333 ., wGO M61 3 ,S,O -139
Contractor City of Ft Collins Sales Tax # Are you paying taxes here or by report? il' Here ❑ Report
Saks tax number is mredbyall c�n&w&vs Are you paying with your trust account? ❑Yes JrN0
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Is this a residential or commercial project? Residential ❑ Commercial
If nesvdenbal, is it. ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
Ni 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 morel ❑ Yes)(No If yes, you may need to contact Hz oncPreservabon
If this is for a demolition permit, what year was the building constructed?
Description of work rL
*If lawn spnnlder/baddlow preventer, must list licensed plumber If first-bme A� /C ust bst licensed electrician
Subcontractors List the company name or QY offt Coffin /Acense #
t !'
Electrician Plumber Mechanical _ Roofer X\116tX.gaather
I hereby acknowledge that I have read this applicabon and state that the above informabon 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
APPiicafit:
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Print NameBf-67 a Z Signature Dade
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Rewslon date zrermn