HomeMy WebLinkAbout3000 Regatta Ln - Applications/Reroof - 04/05/2019� Fcity of Planning, Development, & Transportation Services
ort COIIInS 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 #_ 'J� � as Date
For office use only
Job Site Addre (required) Value f Construction (labor, materials, profs
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Property Owner Nkle Address City/State Zip Ph�onn&^�0�
Adva1V! U04 Am?, rn o _ySextyk 9f Aqov c 80 5 `l
Applicant Name Address City/State ip Phone
�2 tractor Address ity/State C/m�"p Phone
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Contractor City of FIt-lCollins Sales Tax # Are you paying taxes here4r by report? )(Here ❑ Report
Sales tax numberisrequiredbya//contractors Are you paying with your trust account?°"❑ Yes ANo
00137R 7!f
Is this a residential or commercial project? Reside tial ❑ 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/backflow preventer, must list licensed plumber. I rst-time A/C, mulist licensed electrician.
Subcontractors: List the company name or City of Ft Collins license # Ass 04
Electrician Plumber Mechanical Roofer �N 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: J� // i
Print Name:Ntlre l Signatu �t_Da�te—
Revision date 2WO17