HomeMy WebLinkAbout827 Roma Valley Dr - Applications/Reroof - 10/03/2011Fortt-,--ottins
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
❑ Oemolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement Of 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. Incomplete applications will not be accepted.
Application #
For ofce use only
Date ) J - 3 -a 0 `i\
-lob Site Address (reouired>
Value of Construction (labor, materials, profit)
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Property Owner Name
Address
CityjState Zip
Phone
Applicant Name
Address
City/State Zip
Phone
Contractor
Address
city/state Zip
Phone
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
■ Here ❑ Report
sales raxnumber isrWbYredbyall conbaclum
Are you paying with your trust account?
® Yes ❑ No
#S &39
Is this a residential or commercial project? 0 Residential ❑ Commercial
If residential, Is It: ® 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 ®No If yes, you may need to contact Histwic Preservation
If this Is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestns asmssrnent to submit with this application.
Description of work
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*If lawn sprinkler/backlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the Company name or CKy of Ft Collins /icense 0
Electrician Plumber
Mechanical Roofer IR— 15 10 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 constructlon. I know that a
permit is not valid until it has been paid and issued.
Print ant: {� 1 f_T'} j l ^�� Signature Date
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