HomeMy WebLinkAbout416 TEDMON DR - APPLICATIONS - 8/14/2018Aug 02 18 07:32p Severe Weather Roofing 9702233383 p.7
City af Planning, Development, & Transportation Services
Fort Crothns 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 ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stave (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable Information on the application.
PN
Application # 1
fi2r office use only
Incomplete applications will not be accepted.
Date
Job Site Address (required) _ Value of Construction (labor, materials, profit)
Property Owner Name Address City/State Zip Phone
�' n
f+'rlL' fl�i'"!%i I')7 'Yit i �!? '-fill ! ('<l/1?v':? -Dr, �'�=' .'f' L=olt- .s:.F 6,21 q1
Applicant Name Address City/State Zip Phone
"� tf. • .. i f !+' 7' �i; Poe
6,� 1 r.: ii i li) ✓il��f: .�Y ? A •Ll.^� ,trz e�y.,; v�l=r�:� -rji ��: ?`.!- tc;isE�•
Contractor tj J Address City/State Zip Phone
;'ii7of'.'%`,:.i...41P iP��Q.-1'L'd-6l ;hliS .`f'VS i l7V-'1331.' q5,5
Contractor City of Ft. Collins Sales Tax # - Are you paying taxes here or by report? 71-lere ❑ Report
Saks, tax xgb%isrequired byall wnuactors Are you paying with your trust account? '❑ Yes J"o
Is this a residential or commercial project? A Residential ❑ Commercial
If residential, is it: Single Family Detached ElCondo/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 ttiis building 50 years of age or more? ❑ Yes ❑ No Jfyes, you may nead' to contact HlstorfcPresematlon
If this is for a demolition permit, what year was the building constructed?
Description of work �l ziri c l tz . �O: r,�%is .S 647
0 r li; cj- i. �'; fit.
.jGi_ ;•,i �� f `r:IlS :.'./l7ii�c; /1i.;.lil�.l7G'/f --47 4y,. �i (Ci•
J
*If lawn sprinkler/baddiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license #
Electrician Plumber Mechanical Roofer 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
Print (Name: Signature Date
Ravlson Clam BU2017