HomeMy WebLinkAbout715 Parker St - Applications/Reroof - 07/31/2014 (2)07/31/2014 11:05 19702241211
ROCKY MTN ROOFERS
PAGE 01/01
Of Planning. Development & Transportation
Ave P.
t Cothn Fort Collinnsl, CO 80524 O. Box 580
Phone 970-416-2740 Fex224-51M
OVE - HE -COUNTER PERMITS ONLY
This application is to be use dto i pply for the following permits only (check all that applyl, 0 Air Conditioning
O Demolition (interior non- ctura) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Spri ilder Mobile home replacement AAoofing 0 Sewer Line ❑ Photo -voltaic
❑ Ventilation .❑ Water Heats ❑ Water Line Q Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable info 7neltli in on the application. -incomplete applications will not be accepted.
Application # Date
For ofice rase
Job Site Address !Mq&redI
Value of Construction (labor, materials, profit)
.._.........
A7.....
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Property Owner Name
Address City/State Zap . Phone
can l
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2 l llLn EM 3051(-- �d
Applicant Name
Address City/State Zip Phone
Contractor LIC #
Address City/State Zip phone QI'-10
Contractor City of Ft. Collins S
ties T
ix # to ( Are you paying taxes here or by report? ❑ Here Report
Saris taxmcnber*ra7uiredby0c
�jif
Are you paying with your trust account? 0 Yes ❑ No
Is this a residential or commerc al proiderltial ❑ Commercial
If residential, is It: 9*ngle arnily Detached ❑ C0040/bowrihome (single family attached) ❑ Duplex
13 Muitifailly (a rtrnent) 0 Garage
If commercial, Is it 0 Bank 3 Bar 0 Church 13 Hotel/Motel ❑ Medical office 0 Office 0 Retain
❑ Resstaur int C] Other (explain)
Is this building 90 years of or ? ❑ Yes Q No If yes, you may need to mi=t H/srwk Prnsawab'on
If this is for a demolitionIt, t year was the building constructed?
Ifprior to 1975, yrw wf/I need as sent to submit w9h thls epp/lcaftn. _ )
Of
ow
*If lawn sprinkler/baddiow preve iter, n ust list licensed plumber_ If first-time A/C, P mustlistlicensed elktri n.
Subcontractors. Lht lire com y or City of ft Collins liaenw it Crzazd e'rz e R Pxsei rl
Electrician Plu Mechanical RDOW t
I hereby acknowledge that I haves read
comply with all requirements eon fried
Permit is not valid until It has bees
Appilcapt;
Print Name:__. OAJ
"Ti u57 XcLounf
application and state that the above dnfomlahlon Is complete and correct I agree to
Mtn and city ordinances and state laws regulating building construction. I know that a
d and Isshred.
Signature
Dade I - I LI