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HomeMy WebLinkAbout760 Marigold Ln - Applications/Reroof - 08/13/20140R/1A/2014 10:55 19702241211 ROCKY MTN ROOFERS PAGE 01/01 Planning, Development aL TransWfttlan (city Cf COME.; ' 281 N. College Ave P.O. Box 580 Fort Collins, CO 80524 Phone 470-416-2740 Fax 2246134 OVER-THE-COUNTER PERMITS ONLY This application is to be used to ap ly for the following permits only (check all that apply). ❑ Air Conditioning © Demolition (interior non-stru rai) 0 Electrical Alteration (not service change) ❑ Gas lighter 0 Gas Log ;Roofing 0 Sewer Line ❑ Photo -voltaic ❑ Heating Unit Cl Lawn Sprinkler ❑ Mobile Home replacement ❑ Ventilation ❑ Water Heater Wa er Line ❑ Wood/Pellet Stove (must be SPA certified, provide make, model and manufacturer). Complete all applicable. Information Application # c3 on.the application. Incomplete applications will not be accepted. L Date�SS_ Aea Lq For otf/ce use on Sob Site Address (required) Value of Consbvction (labor, materials, profit) Property Owner Name Address City/State Zip Phone S 652S (oV-7(oqS Applicant Name Address City/State Zip Phone Contractor uc # -1'1 3 Address City/State Zp phone OnO 0 GKr+ YCbutu+` ►� Contractor City of Ft Collins Sales 7a # LA ,�"tilp Are you paying taxes here or by report? ❑Here j4 Report Are you paying with your trust account? Yes ❑ No SaiestaxnumbertsragWradbyailcan Is this a residential or commenda If residential, Is -it: '0&S1ngle'F project? mlly RResidendal EICommerdal etadaed O•Condo/tnwAhome•(single family attached) O Duplex ❑ Multifam ly (ap rtment) © Garage If commercial, is it: ❑ Bank L Bar 0 Church 13 Hotel/Motel ❑ Medical office ❑ Office 13 Retail CI Restaura it C] Other (explain) Is this building 50 years of age or mo ? O Yes O No if yes, you mayneed to cuniactHistUAC Preservai7on If this is for a demolition perm It, wh year was the building constructed? Ifprior lu 1975, you wi// need a assessnte»t 10 submit NtiHr this app/lradan. O r. Description of work *If lawn sprinkler/baddiow preven er, mi A list licensed plumber. If first-time A1C, must list licensed eldchir n. subcontractors: List Lfie compan v nam or C7ly ofFtCv//ins dcense # EQecWdan Plumb er Mechanical Roofer Other I hereby acknowledge that I have i ead tt is application and state that the above information is complete and correct. I agree to comply with all requirements conta red h reln and city ordinances and state laws regulating building consductlon. I know that a permit is not valid until It has I een 1 aid and issued. Applicant: /i% 1 Print Name: Signature Date 'Tru57 kccoun+ i