HomeMy WebLinkAbout1413 E Stuart St - Applications/Reroof - 06/27/201406/27/2014 09:00 19.702241211 ROCKY MTN ROOFERS PAGE 01/01
P1;snning, ilYevelopment IN Transportation
City of 281 N. College Ave P.O. Box 580
rt
CoUins Fort Collins, CO
�� Phone 970-416-277404 Fax 22+6134
OVEFt-TOE-COUNT TER PERMITS ONLY
This application is to be used
to ar
ply for the following permits only (check all that apply). ❑ Air Conditioning
❑ demolition (interior non-stru
❑ Lawn SprInI
ral)
Jer C
❑ Electrical Alteration (not service change) 13 Gas Lighter ❑ Gas Log
Mobile Home replacement Acofing ❑ Sewer Line ❑ Photavoltaid
❑ Heating Unit
t7 ventilation ❑ Water Heater
❑ Wi
ler Line ❑ Wood/pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable info
on the application. Incomplete applications will not be accepted.
Application # 04D�
M
Date 4 • ��'
y
• for office use of,
]ob Site Address (required)
Value of Construction (labor, materials, profit)
Property Owner Name
Address City/Slate Zip Phone
nIAMA: • JW It'd
6 1 i ciur `.fit 58l •SCc4
Applicant Name
Address City/State Zip Phone
Contractor Uc #
c-
3 Address City/State ap Phone (Y10
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Contractor City of Ft. Collins Sc
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# L.l I 'ajr) p Are you paying taxes here or by report? ❑ Here X Report
Are paying with your trust account? Yes ❑ NO
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you
Is this a residential or commer A pro ? MPesidential ❑ Commercial
If residential, is it: '®.Single' amlly i etached ❑ Condb/tofthomb (single family attached) ❑ Duplex
l7 Multifa ifly (apartment) ❑ Garage
If commercial, is it: ❑ Rank 3 Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office 13•Retabi
❑ Restau nt ❑ other (explain)
Is this building so years of ag i or m e? ❑ Yes O No tf yes, you may need to mntatt H&taiic Pmservadon
If this is far a demolition p lt, t year was the building constructed?
Ifprior to 1975, you Will needap a assessment to submit with this. applletion.
of work
*If lawn sprinkler/backtlow prow ter, r list list licensed plumber. If first-time A/C, must fist licensed eldch ician.
Subcontractors: List Me compj ny na or Gty of ft Collins tense #
dectrtGan Plur ibar�_ Mechanical Roofer _.._ Other
I hereby acknowledge that I ha read this application and state that the above information is complete and correct I agree to
comply with all requirements co red herein and city ordinances and state laws regulating building construction. x know that a
Permit Is not valid until it ha been paid and issued.
Applicant:
Print Name: L
signature
gate �oa`�4 . )i-�' -
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