HomeMy WebLinkAbout2709 Rock Creek Dr - Applications/Reroof - 08/26/2014From: All Phase Restoration Fax: (970) 622-2057 To: City of Fort Collins Pern Fax: +1 (970) 224-6134 Page 1 of 4 08126r2014 3:12
Planning, Development a Transportation
E� ft C f 281 N. College Ave P.O. Box 580
o i �r���I�s Fort Collins, CO 00524
Phone 970.416-2740 Fax 224.6134
OVER-THE-COUNTER PERMITS ONLY
This application Is to be used to apply for the following permits only (check all that apply). ❑ Air'Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation 17 Water Heater ❑ Water Line ❑ Wood/Pellet Stove (musf be EPA certified, provide make, model and
manufacture j, n
Complete appfe bie inf�aticatto� complete applications will hot be accepted.
Application# L{� fj /(Jl ��/, / Date �� Z (o/y �� J • c l
For o>Troe use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
Z7 Ct-C�/.
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Property'Owner Name Address
C// 40!!:�
City/State Tip Phone
'_9A/Ye 773 677- fro
Applicant Name Address
City/State Zip Phone
e9 >o� lodes -7�a
Contractor Address
35-5
WState Zip Phone
AAAo CU 6oss�
Contractor City of IL Collins Sales Tax #
Are you paying taxes here or by report? kliere ❑ Report
SIlestrxmmberismqu1Wbyall cm&aciom
Are you paying with your trust account? ❑Yes XNo
Is ibis a residential or commercial project? X Residential ❑ Commercw
If residential, Is it Single Family Detached ❑ Condo/townhome (singlefamlfy attached) ❑ Duplex
Multifamily (apartment) ❑ Garage
If commercial, Is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is tht5 building 50 years of age or more? ❑ Yes X N0 If yea, you may need to contact Hlstodc Preservation
If this is for a demolition permit, what year was the building constructed?
Ifpn& to 1975, you will need an asbestas assessment to submit with this application.
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*If lawn sprinkW/baWow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the champany name or oty of Colft /i=se #
6eculdan Plumber Mechanical Roofer Other
I hereby'BdQwvAedge that I have read this application and state that the above Information is complete and correct. I agree to
comply with all t'equirementS contained herein and city ordinances and state laws regulating building construction. I blow that a
Permit is not valid until it has been paid and issued.
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