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HomeMy WebLinkAbout3000 Regatta Ln - Applications/Reroof - 04/08/2019FCity of Planning, Development, & Transportation Services ort 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. App!Icw�on # l -I �� ✓a« For office use only Job Site Address (required) Va ueof Construction (labor, materials, proms) Property Owner , e Address City/State Zip Phon ,4�va�r a o Y 110 c S© as -Sa Applicant Name Q Address City/State ip Phone 3 INallker5 un'r�odmdgkwG co,$0// ° "^ tractor Address City/State C7 ip Phone ,. Contractor City of ft1tiCollins Sales Tax # Are you paying taxes her r by report? Here ❑ Report Sales tax number isrequired byall ronbactom Are you paying with your trust account? ❑ Yes ^No 00137� �� 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 work e _ r' 6 a. *If lawn sprinkler/backnow preventer, must list licensed plumber. I rst-time A/C, must � list licensed electrician. Subcontractors: List the company name or City of ft Collins license # A f I/ Coo3t Y,ICHrleo Electrician Plumber Mechanical Roofer Other I hereby acknowledge that I have read this application and state that the above information is complete A 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 NamMire e: Signatu N-94et Date r Revision date 2/6/2017 FA