HomeMy WebLinkAbout3039 Regatta Ln - Applications/Reroof - 04/08/2019 (3)City of Planning, Development, & Transportation Services
Fort 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 �a{pplicable information on the application. Incomplete applications will not
F/bbeI1I accepted.
P9pplicatiOn ir_ �� 6 ��� Late
For office use only
Job Site Add (required) V lue f Construction (labor, materials, prof
Property Owner Naw Address City/State Zip Phon
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Applicant Name Address City/State ip Phone
�^ tractor Address ity/State �� ip Phone_
8 _ a a a
Contractor City of Collins Sales Tax # Are you paying taxes her r by report? Here ❑ Report
Sales tax number is required by all contractors.
Go13757�j Are you paying with your trust account? ❑Yes Vo
Is this a residential or commercial project? Residential ❑ Commercial
If residential, is it: ❑ Single Family Deta ed XCondo/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? ❑ Yes)(No Ifyes, you may need to contact Historicpreservation
If this is for a demolition permit, what year was the building constructed?
esscri tion of work S (� 6
15
*If lawn sprinkler/backflow preventer, must list licensed plumber. Y rst-time A/C, must list licensed electrician.
Subcontractors: L& Me company name or City of R Collins license # As axf, ��
Electr ciao Plumber Mechanical Roofer Other
I hereby acknowledge that I have read this application and state that the above information is complete aridl 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: %� // I /�
Print NameNttre / a �/�5 Signatu
Revision date 2/6/2017
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