HomeMy WebLinkAbout3500 Rolling Green Dr - Applications/Reroof - 08/04/2014 (2)Planning, Development & Transportation
City
}of 281 N. College Ave P.O. Box 580
ForrCollinslFort 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.
on I
Application #
For office use only
Date
Job Site Address (required)
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10 F Value of Construction (labor, materials, profit)
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Property Owner Name
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Address City/State
Zip
Phone
Applicant Name
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Address City/State
�Zip
Phone
Contractor
Address City/State
Zip
Phone
Contractor City of Ft. Collins Sales Tax #
Sales tax number is required by all contractors Are you paying with your trust account?
❑ Yes 1237No
Is this a residential or commercial project? RResidenbal ❑ Commercial
If residential, is it: ,ogle Family Detached tondo/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 plYor to 1975, you will need an asbestos assessment to submit with this application.
Description of work re/tiovc c1- ULU. 2 gS4C t.++� nc.� V
*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 " Z y46 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 Namel)C/�"�'� �`S" Signature a