HomeMy WebLinkAbout3105 Regatta Ln - Applications/Reroof - 04/08/2019 (5)FCity of planning, Development, & Transportation Services
lirt 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 ❑ 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 #
For office use only
Date
Job Site Address (required) Val a of Construction (labor, materials, profit)
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Property Owner hake Address City/State Zip A.
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Applicant Name Address City/State ip Phone
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r-„ tractor Address ity/State C/wuvc ip Phone S_
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Contractor City of 06kollins Sales Tax # Are you paying taxes herE4r by report? Here ❑ Report
sWestax number isrequired byalfcontractors. Are you paying with your trust account? ❑ Yes ^No
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Is this a residential or commercial project? Reyside ❑ Commercial
If residential, is it: ❑ Single Family Deta ed Condo/townhome (single family attached) ❑ 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? ❑ YesXNo If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
esscri tion of worke 5
*If lawn sprinkler/backnow preventer, must list licensed plumber. I rrst-time A/C, mus
gt list licensed electrician.
Subcontractors: Ust the company name or City of Ft Collins license # ASJ f
C-0 W,0 ` A
Electrician Plumber Mechanical Roofer Other
I hereby acknowledge that I have read this application and state that the above information is complete an 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: /ri 614e % al ff� `
Print Name: r�� l / � Signatu r Date r
Revision date 2J 2017