HomeMy WebLinkAbout241 Cordova Rd - Applications/Reroof - 05/29/2019a815-To
Planning, Development, & Transportation Services
_.fort C®«Ii�S Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main: 970AI6.2740 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 X Roofing ❑ 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.
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Application # 1 ✓1 _ 1 O ✓���
Forofce use only
Incomplete applicrations will not be accepted_
Date "/ I")
lob Site Address (required) Value of Construction pabor, materials, profit)
aNI o dove , Rol . ofti,n5 � 3L4 lD .2y
Property Owner Name Address City/State . Zip Phone
Cn gone C o►Ie i a-fe. Comrnu.ni-Vi eS t. fall s - 95- L0705
Applicant Name Address City/State Zip Phone
RTC RD4in 63Lf2 E C: 17 SahInSA-DWfI eo ED 53y
Contractor Address City/State Zip Phone
cSa►Nie aS cbave., 971D-tD63-3yo0
Contractor City of Ft Collins Sales Tax # Are you paying taxes here or by report? V Here ❑ Report
selestaxnumber[srwred byaGmntrd�xs Are you paying with your trust account? ❑ Yes �(No
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Is tills a residential or commercial project? V Residential ❑ Commercial
If residential, is it: ❑ Single Family Detached i4Condo/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 IgNo if yes, you may need to contact Historic Preservation
If this Is for a demolition permit, what year was the building constructed?
Description of work Te cur o P t re fo o- 4 2- . Cc U .Sq u o-re 5
:1—'KD C11155 SVliA jle.5 RTC crews-. Z. Storm Lu idina
*If lawn sprinlder/back iow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: L& the company name or City of Ft Collins license #
9echidan Plumber Mechanical Roofer (?p 83 Other
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: - �- V C
Print Name: �J U IQ. S+OGh- Signature Date
PiMsim data M=17