HomeMy WebLinkAbout4550 Larkbunting Dr - Applications/Reroof - 08/21/201408/22/2014 08:36
211
ROCKY MTN ROOFERS
PAGE 03/10
Cityof
Fort Collins
GVE$-7
This application is to be used to
❑ Demolition (interior non-stnsctun
• Heating Unit ❑ Lawn Spridider
O Ventilation O Water Heaters ❑'
manufacturer).
Complete all applicable infotnud
Application # 611 D 1,0: y 1
For aurae use only
Sob Site Address (mquired)
PlanWag, Development & Transportation
281 N. College Ave P.O. Box 580
Fork Collins, CO SOS24
Phone 970-416r2740 F:•nc 224-G134
PERMITS ONLY
fly for the following permits only (check all that apply). 13 Air Conditioning
:3 Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Lag
Mobile Home replacement Roofing ❑ Sewer Line ❑ Photo -voltaic
er Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
on the application. Incomplete applications will not be accepted_
Date �� )
Value of Construction (labor, mabarials .profit)
$ )Tel oa : o
Property Owner Name
Address I
City/State Zip
Phone
Applk6t Name
Address
city/stage Zip
Phone
Contractor Inc # , )
$5 Address
Cdy/staw 21p
Phone COO
f.0 Cjr'� Y VLL4-Aw n
der e
45 S. U r\
�`iC. CAD �i�a -
cZyA (�
Contractor city of Ft. Collins 581es T
x # L4 > tj"lt p
Are you paying saxes. here or by report? ❑ Here id Report
sorer tar aumeerrs rewlrevdayAl co'ntr
Are You paying with your bust: account? )(( Yes
❑ No
Is this a residential or eommerclal pro eck? lid Residential 13 Commercial
If residential, is it: 0 Single tarfiffy Detached 0 CAndo/townhome (single family attached) CI Duplex
WMultifarlrily (a partment) 0 Garage
If commermi l l,'is it: ❑ Bank C3 Bar El Church 17 Hotel/Motel ❑ Medical office O Office 13 Retail
0 Restaurbnt C3 Other (explain)
is this building 50 years of 00 or rr ore? E3 Yes Q No If yes, you may need to contact historic oreservadon
if this is for a demolition perrhit, w t ,year was the building constructed?
Ifprior to 1975, you w111 need aln a assessrnent tv suhmk wit this appAca&n.
Description of work
*If lawn sprinkler/baddiow prev8rtter.
SubconbaCtorsr List ffiecumpoy/A
VecWdan
I hereby acknowledge that I
comply with all requirements
permit is not valid urntil it
Applicant:
Print Naive:
1 i' ,5.-r %CC. ow1'l'
t list licensed plumber. if. first-time A/C, must list licensed el kmclan.
or Qty afFt Co111nshcw%e
Media Roofer
read this application and state that the above information is complete and correct I agree to
tined n and city orcrmances and state laws regulating building construction. I know that a
beerq paid and issued.
Signature
1� Q-1CIL�