HomeMy WebLinkAbout836 Rumford Ln - Applications/Reroof - 10/07/2011City of Planning, Development & Transportation
Fort Collins Fort N. College Ave P.O. Box 580
I Collins, CO 80524
Phone 970-41616-2740740 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.
le
Application # ! l 6 O �z::2- 3
For office use only
Incomplete applications will not be accepted.
Job Site Address (required)
Value of Cgnstruction
(labor, materials, profit)
RUM690 1,J6J
Z 33
Property Owner Name
Address
City/State
Zip
Phone
go_ AaAj
Applicant Name
Address
City/State
Zip
Phone
Contractor
Address
City/State
Zip
Phone
&eolkotltz 6310
1544
n *02
(I 1
S" trd3}O
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
XHere ❑ Report
Sales tax number is required by all contractors.
Are you paying with your trust account?
❑ Yes KNo
Is this a residential or c mmercial project? X 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 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: ERI 6'1144 signature Date b