HomeMy WebLinkAbout3024 Ross Dr - Applications/Reroof - 03/19/201203/19/2012 09:42 19702241211 ROCKY MTN ROOFERS PAGE 01/01
Fort Collins
Wannbeg, Developnxtnt & Transportatlon
281 N. College Ave P.Q. Box SW
Fort Collins, CO 80524
Phone 970.416-2740 Fax 224-6134
OVEWTHE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). p Air Conditioning
0 Demolition (interior non-structural) 0 Electrical Alteration (not service change) ❑ Gas Lighter 0 Gas Log
❑ Heating Unit 0 Lawn Sprinkler ❑ Mobile Home replacement ARoofing 0 Sewer Line 0 Photo -voltaic
❑ Ventilation 0 Water Heater ❑ Water Una ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicableji °rrmatii on the ppiication. Incomplete applications will not be accepted.
Application # /—O J Dam
For offlm rose only
fob Site Address (regWW9 Value of Conction 0abor, materials, profit)
30a4 too ss Dx(� B -/� $ struSa
Property Owner Name Address 3 City/State Zip
Phone 372
FA46 6rnu E g
r7G
Applicant Name Address
City/5tate Tip
Phone
Contactor Lic # �'.-1-1� Address
KQ C W[xi:ny&z n
Gty/State Zip
Phone cnO
�56 5.1� n
ink C, gC�Z
2Z�1-I 2,00
Contractor City of FL Collins Sales Tax # Ll \
Are you paying taxes here or by report? ❑ Here
)t Report
1;3/es rarnrmrbPrs feq edbyall awmanbm
Are you paying with your trust account? J4 Yes
❑ No
Is this a residential or commercial project? N(R 1 ❑ Commercial
If residential, is it -0 Single Family Detached do/t ownhome (single family allzOed) ❑ Duplex
0 Multifamily (apartment) ❑ Garage
If commeroial, is it 0 Bank O liar ❑ Church D Hotel/Mote! ❑ Medical office 0 Office Cl Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes b No B°yes, you may veep to GnirladtMStoflC pfe q n don
If this Is for a demolition permit, what year was the building cAnstructed?
IfpnW to 1975, you WI/ aeW an a0estas assessment & submit *0 bl& applleabbn.
Work
*If lawn sprinlder/baddlow preventer, must list licensed plumber. If Mst;dT A/C, must lisVicensed
Subcontractors: Izf Me company name or GLy of Fe C.o1//ns kcense A /u l7?me—r—
demiaan Plumber.
Medrankal Roofer
Other
I hereby admow.l dge 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: .r/oAj
Print Name Signature
Date 3 -19 iA
1 rusT XCCM/ -