HomeMy WebLinkAbout730 Rochelle Cir - Applications/Reroof - 07/31/2013City of 0uc Planning, Development & Transportation
/ F61^'t 281 N. College Ave P.O. Box 580 2
` Collins Fort Collins, CO 80524
��\ Phone 970-416-2740 Fax 224-6134 �.6/)
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all,that apply). O Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not servic hange) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement 3VRoofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable inforrmSaNtio'n�7o the placation. Incomplete applications will not be accepted.
Application #.. f 5 i WS0"(V Date 7 31 Zo/ _
For bfte use only —
lob Site Address (required)
Value of Construction (labor, materials, profit)
L' "'►4 1 $ 17 � Qa
Property Owner Name
Address
City/State
Zip Phone
o
FOrk
zt 97�.q[6,
Applicant Name
Address
City/State
Zip Phone
Z3
5 .
LAW.
8=1 =�
Contractor Lic #
Address
City/State
-,k
Zip Phone
Contractor City of Ft. Collins Sales Tax
Sales tax number is required by all contractors
Are you paying taxes here or by report? if?l�ere ❑ Report
Are you paying with your trust account? ❑ Yes G No
Is this a residential or�co�ercial project? 8 Residential ❑ Commercial
If residential, is it: Q'Single 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 may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/backflow 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: J06ule, 30ssc) —
Date —1��-- -