HomeMy WebLinkAbout114 Fishback Ave - Applications/Reroof - 09/05/201309/04/2013 09:46 19702241211 ROCKY MTN ROOFERS PAGE 01/01
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Z81 N. College Ave P.O. DUX 5W
Fort Collins, Co SO524
Phone 970-416-2740 Fax 224-6134
NTER PERMITS ONLY
This application is to be used to ply for the foftowing permitsonly (check all that apply). 0 Air CondWoning
0 bemolfhon interior norfstructurail Ej Electrical Alteration (not service change) cl Gas Lighter 0 Gas Log
[]'Heating Unit [I Lawn Sprinkler Mobile Home replacement ng ❑ Sewer Line 0 Photo -voltaic
l] Ventilafion ❑ Water H .eater 0 Wider Line 0 WooNPeltet Stave (mug, be EPA certified, provide make, model and
manufacturer).
Complete all applicable intormaii on the appiiCation. fnComPkft
a PtiCat}ons KtiEt oat be accepted.
application # b C� Da
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Sob Site Address (/mod%
Property Owner Name
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Applicant Name
CuntracGQr be # `
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Coniradnr City of Ft Collins Sales
Sales tar mffn is regdrrOW aff
Is this a residential or cmrmwcial p
IF resk t 1, is It: P Single Faun
❑ hluKlfarnify
If commeram, is it 0 Bank ❑ H
0 Restaurant
7s this building so years of age or
if this is for a demoTdon Pit
if p1W A71975 �vu wX need an a<
1-M0T•••. • -•
*If lawn qirinkWAiaddlow peverdr-F,
subcontractors: [ file WMPM7y M
Value of ConfiUuctlon (tatxrr, materials. Profit)
n
Address City/state Zip Phone 7o "
Address aLy/Staff ZEp Phone
Address City/State Tap Phone �—[G
%5 `' U :�V,\2 ctD !a, ZZkA-1ZGt
# X A l 75-JU Are you paying taxes here or by report? 0 Eiere )4 deport
Are you paying with your trust account? X Yes ❑ No
37 % Reskler>tial 11 Commercial
etad,ed 0 CwidWtownhome (sMgle femlty awxhed) 0 Dupkx
irtm nt) 0 Garage
❑ Church ❑ Hotel/Motel D Medical office 11 Office 0 REW1
❑ Other (explain)
e? 0 Yes to No If yes, yvu msry need to cm7&xl Hfitcvk Pleswvabbn
t year was the building constructed?
k79a9eZVjB?tt0 subnW "Ah dYSapp&360a
t fist ke lsed piumtw- If first-time MC, must Ikt kwwed
oaralrefTcwhTuse&a- cnd !L,41,h9
I hereby admowkdge that I have reW appkabon and statiE that the above Wbrmalion Is mnrple;e and correct. I agree to
comply vt@h all requwemef'its contabied herehi and city ordinances and state laws regulating burg ox.mtruction. i (mow that a
parmit is jmt valid unbi it hats been paid and Issued.
"MUCant Date �I hit►
Print Naitte s
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