HomeMy WebLinkAbout3105 Regatta Ln - Applications/Reroof - 04/08/2019 (2)FCity of Planning.. Development,. & Transportation Services
ort COltins 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 # P vl Va 1 1 q Date
For office use only
Job Site Address (required) alue of Construction (labor, materials fit)
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Property Owner a Address City/State Zip Phon
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Applicant Name Address City/State ip Phone
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�oqtractor Address ity/State �r� ip Phone_
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Contractor City of I-t-kollins Sales Tax # Are you paying taxes hereAr by report? Here ❑ Report
Sales tax number is required by all contractors Are you paying with your trust account? ❑Yes to
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Is this a residential or commercial project? XReside tial ❑ Commercial
If residential, is it: ❑ Single Family Detached 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 Ifyes, you may need to mntactHistoric preservation
If this is for a demolition permit, what year was the building constructed?
esscri tion of work e
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*If lawn sprinkler/backflow preventer, must list licensed plumber. I trst-time A/C, must
list licensed electrician.
Subcontractors: list the company name or City of Ft Collins license # / iss ax, afi vt
Electrician Plumber Mechanical Roofer C--,.AA Other
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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: /� (�� t �.� Signatu Date
Revision data 2/6/2017
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