HomeMy WebLinkAbout6714 Rose Creek Way - Applications/Reroof - 11/17/201111/17/2011 02:25 3032384051
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INTERSTATE ROOFING
PAGE 08/14
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
D Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
O Heating Unit ❑ Lawn Sprinkler O Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
0 Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified. provide make, model and
manufacturer).
application. Incomplete applications will not be accepted.
Complete all applicable information on the
Application # I `VIV) _ Date I t t I
Fn/- Ofre- use only
Is this a residential or commercial project? O Residential ❑ Commercial
If residential, is it: ❑ Single Family Detached C�,_ondo/townhome (single family attached) D Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar C:) Church ❑ Hotel/Motel ❑ Medical office O Office O Retail
❑ Restaurant ❑ Other (explain) - is this building 5o years of age or more? O Yes pro If yes, you may need to cartact flistOnC Preservation
If this is for a demolition permit, what year was the building constructed?
/f prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work o ,
*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 a
Electnuan-_,,,,,r _ Plumber
Mechanical! Roufer _!� / " Other
i liereby 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: �� jj'�� t
Print Name:�Q�.yLl�tuf�lSignature Oate --.