HomeMy WebLinkAbout457 RIVA RIDGE DR - APPLICATIONS - 4/26/2016Apr 2716 03:31 p Severe Weather Roofing
9702233383 p.3
Fort Collins
1110
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 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
0 Demolition (interior non-structural) ❑ Electrical Alteration (not servfe� change) 0 Gas Lighter O Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement oofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ WoodiPellet Stove, (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # �.1sC.�I��Z.C�'T. Date 9* AD/' Z®��
Forofce use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
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Property Owner Name Address
City/State Zip
Phone
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Applicant Name Address
City/State Zip
Phone
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Contractor Address
City/State Zip
Phone
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Contractor City of Ft. Col Ins Sales Tax #
Are you paying taxes here or by report?
ere ❑ Report
Sales tax number is required by allcono?gors
Are you paying with your trust account?
0 Yes 9-15�"
Is this a residential or cfl��rcial project? LKesidential ❑ Commercial
If residential, is it: mingle Family Detached ❑ 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? ❑ Yes o If yes, you mayneed to contact Historic Preservati"on
If this is for a demolition permit, what year was the building constructed?
If prior la 1975, you will need an asbestos assessment to submit with this apphcatlon.
Description of work R&ne- �2 �
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*If lawn sprinkler/backfiow preventer, must list licensed plumber. If first-time A/c, must list licensed electrician.
Subcontractors: LW 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: -r�
Print Name,-, ✓��., Signature
Date 1:6 -Air-zvr'"6