HomeMy WebLinkAbout2620 Arancia Dr - Applications/Reroof - 08/28/201408/28/2014 09:29 19702241211 ROCKY MTN ROOFERS PAGE 01/01
Planning, development & Transportation
281 N. College Ave P.O. Box s8o
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224134
UVEWHE-COUNTER PERMITS ONLY
This application is to be us�d to ly for the following permits only (check all that apply). 0 Air Conditioning
❑ Demolition (interior non- etu 13 Electrical Alteration (not service change) ❑ Gas Lighter [3 Gas Log
❑ beating Unit ❑ Lawn Sp nkler ❑ Mobile Home replacement Roofing ❑ Sswer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water He r ❑ ater line d Wood/Pellet Stove (must he EPA certified, provide make, model and
manufacturer).
Complete all applicable ma ' on on the application. Incomplete applications will not be accepted.
inidr
Application # Z Date t� •��S .1�
Forolixe use y
]ob Site address (mquvad) Value of Construction (labor, materials, profit)
LD'�-00 i z $
Property Owner Name Address city/state Zip Phone
Applicant Name ; Address Gty/State .
Zip Phone
contractor Lit # W,, Address City/state Zip Phone C '-10
i p
2, Li viz FIC, c�aZ►-I 22- -1 Zc7G
Contractor City of FL Collins les ax # u 1 �-,nu Are you paying taxes here or by report? ❑ Here jd Report
-qzW taw number Is raquh M Are you paying with your trust account? g Yes ❑ No
IS this a residential or comm i pro ect? 18 Residential D commercial
If residential, is it- IN Single arnll Detached 17 rondo/townhome (single family attached) 0 duplex
0 Muitifa fly (a partriient) i] Garage
If commercial, is it: 0 Bank ❑ Sat 0 Church 13 Hotel/Motel ❑ Medical office 0 office ❑ Retail
U ReStdu fit 0 Other (expldin)
Is this building 5o years of a or re? O Yes 0 No ff yes, you mayneed to contact Hlsinr/e P�rvatton
If this is for a demolition pe , w year was the building constructed?
Irpt/or to ,t975, ynu wi/1 pees ascent to submit we this app#oaon. ► � �
Description of work
aCj
*If lawn sprinkler/backfiow pre4ter; n lust list licensed plumber. If first-time A/C, must list ilcensed dan,
Subcontractors; tL4 the M"m V na a or Gty ofa Co//ins license #
sedridan Pl Ilurtf_er MediankaL__` Roots Other
I hereby acknowledge that I have readBid
appllcatien and stabs that the above information Is complete and connect. I agree to
comply with all requirements co 'nedin and city ordinances and State laws regulating buflding construction. I know that a
Permit is not valid until it has �heen and issued,
AnAkant:
Print Name Signature 77 pate 9 ' ; 1
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