HomeMy WebLinkAbout1851 Rosemary Ct - Applications/Reroof - 10/03/2011SS 5 Planning, Development & Transportation 2
City 281 N. College Ave P.O. Box 580
FOIry}l Collins 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
❑ 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 Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # C W)k Date 3 ^a)-6
For office use only
Job Site Address (Ed)
Value of construction (labor, materials, profit)
ProperProDertv. Owner Na
ress
City/State Zip Phone
Applicant Name
Address
/State Zip Phone
J o
09
0 •.- j Szs 976 b M
Contractor
Address
0 City/State Zip Phone
Contractor City of Ft. Collins
# .
Are you paying taxes here or by report? ❑ Here E% Report
Sales tax number is reqwred by all
Are you paying with your trust account? ;KYes ❑ No
Is this a residential or commercial project? 0 Residential ❑ Commercial
If residential, is it: At 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 :gLNo 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 appftcadon.
Description of work
*If lawn sprinlder/baddiow preventer, must list licensed plumber. If first-time A/C, must IistJicbnsed electrician.
Subcontractors: List Me company name or City of Ft Collins license #
Electridan Plumber Medianical 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