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HomeMy WebLinkAbout3039 Regatta Ln - Applications/Reroof - 04/08/2019 (2)Fcity of Planning, Development, & Transportation Services ort Collin$ 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 °�j2oofing ❑ 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. r`1.plir.aautvn tr LUOIC b��- For office use only Job Site Address (required) Value of Construction (labor, materials, profit eg �# 8 `CS Property Owner Na Address City/State Zip Phon �4Rva�r a XA® Y �r�` S`F 7, ru C SQ a6 _199 Applicant Name Address City/State ip Phone gom �� tractor Address Jity/StatelStm ip Ph;3 h. 8- # a 1 Qac CA ©/l Contractor City of Aicollins Sales Tax # Are you paying taxes he r by report? Here ❑ Report sales tax number isrequredbyall mn&actors Are you paying with your trust account? ❑ Yes XNo 0 01-17? 1 y Is this a residential or commercial project? Residential El Commercial If residential, is it: El Single Family Deta2e 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 SO years of age or more? ❑ Yes'(No If yes, you may need to contact Historic Preservation If this is for a demolition permit, what year was the building constructed? 17 esscri tion of work e ,S r 6 *If lawn sprinkler/backnow preventer, must list licensed plumber. I first-time A/C, must list licensed electrician. Subcontractors: List the company name or City of Ft Collins license# Ass 1Q CbYI� /Yt� 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: %� // t �/ ,o �% % Print Name:li Vl % e 1Jf) , 1. 6 Signatu Date c ! Revision date 2162017 i