HomeMy WebLinkAbout5513 Saratoga Cir - Applications/Reroof - 08/18/2014If commercial, is it:
06/18/2014 09:03 19702241211
ROCKY MTN ROOFERS PAGE 01/01
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City}CO
i a,,,,, ,.. lPtanningr iDevelopment & Transportation
281 N. College Ave P.C. Box 580
art1�C 1n
Fort Collins, CO 80524
Phone 97G-416-2740 Fax 22"134
OVEIlt-JCI
E-COUNTER PERMITS ONLY
This application is to be u ty
for the following permits only (check all that apply).13 Air Conditioning
❑ Demolition (interior non-atrutu
Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
C7 heating Unit ❑ Lawn SprinkleMobile
Home replacement Roofing ❑ Sewer Line 0 Photo -voltaic
0 Ventilation ❑ Water Heuer, 0r
Line Cl Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
!
Complete all applicable Informatloirt
on the application. incomplete appifoatione will n be accepted.
Application # ('i (,� 3
! 1 Date
For of9re use o►b/y
]ob Site Addr (rerwm�dl
Value of Construction (labor, materials, profit)
Property Owner Name
Address
City/State Zip
Phone
II'
Applicant Name
I Address
city/state Zip
Phone
Contractor Lic # K -1^(
f to VP YY�u �1z�c r1
3 Add;;
�y
City/State Zip
-
Phone 01-10
a
S . Q (\
AJL ETC,gQ=-nZ
22y ... II Z.C—)D
Contractor City of R. Collins Sales Ta
c # U l 7tnLe
Are you paying taxes here or by report? 0 Here
Pf Report
Sales tar number /s 1equlred by a(/ M
Are you paying with your trust account? g Yes
CI No
Is this a residential or
If residerI ial, is It: &Single
Muttlfa
❑ Bank
0 Restau
Is this building 50 years of age
If this is for a demolition perm'
lFpdor to 1975, yrw wf//need an
of work
p ? 1111111Residential C3 Commercial
ttlry I WG3ched 0 Condo/townhOme (single ramify attached) ❑ Duplex
y (ap irtment) ❑ Garage
Bar E3 Church ❑ Hotel/Motel ❑ Medical office C3 Office 0 Retail
t 13 Other (explain)
rr ? ❑ Yes O No If^ you may need m 0j64 ct H1sfwk Preservation
year was the building constructed?
9ese53nent L9 submit *0 MIS app/ka>Yoa
*If lawn sprinkler/baddiow pmventier,.m t list licensed plumber. If first-time A/C, must list licensed elktridan.
Subcontractors: List bye comprnl ftaM4 or ply Of Cocain #=m d ou O-r/ %X W\ s^.f VC
Elechidan PIUmb�r }- Medwical Roofer other
I hereby acknowledge that I have r*ad tho application and state that the above Information is Complete and correct I agree to
comply with all requirements contairted n and City ordinances and state laws regulating building construction. I knout that a
permit Is not valid until It has been p4ld and issued.
Applicant:
Print Name: 01V
"T"rus7 Ac,c.aurt+
Signature
Date 3"V1 O%i