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HomeMy WebLinkAbout5201 Stillwater Creek Ct - Applications/Reroof - 09/03/201409/03/2014 13:31 19702241211 ROCKY MTN ROOFERS PAGE 03/07 City of Flirt Collins OVEW This application is to be used to ❑ Demolition (interior non-struCtun Q'Heabng Unit ❑ Lawn Sprinkler El Ventilation 0 Water Heater ❑' manufacturer). Complete all applicable informal Application # i For office M cnly Planning, Development & Transportation ;.. . 281 N. College Ave P.O. Box 580 Fort Collins, CO 80524 Phone 970-416-2740 Fax 224.5134 PERMITS ONLY )ly for the following permits only (check all that apply). E3 Air Conditioning I Electrical Alteration (not service change) El Gas Lighter 0 Gas Log Mobile Home repiacement Aoofing 0 Sewer line E3 Photo -voltaic er Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and on the application. Incomplete applications r will not be accepted. ,I 4-i0-74il7I Date • -y . 14 Sob site Address (required) I Value of Construction (labor, materials, profit) r? -. crr.I.._L_ , h__lt. AL f $ -'gan')Qo tC�0_ Property Owner Name Address city/Stage zip Phone -%CC-�o ��•use-�� a Applicant Name Address City/State Zip Phone Contractor Uc # 1 err ii�7�l �' 41 �J Address City/State 71p r Z5, % 1 r .. R- 7-TCr c`$ J2 Phone QI-IG i2�i - iZC i Contractor City of FL Collins Sales i SekS h?xnumberisrequirearbya/i 3x # LA Are you paying taxes here or by report? 13 Here Are you paying with your trust account? ji(( Yes ji;( Report ❑ No Is this a residential or commercial pro cct7 11111 Residential ❑ Cmmerdal If residential, is it: '0i Single 'Fanilly Detached O'Condo/townhome (single family attached) ❑ Duplex 17 Multifathily (a partment) O Garage If commeraai, is it: 0 Bank P Bar © Church ❑ Hotel/Motel ❑ Medical office ❑ office O Retail d Restaurant ❑ other (explain) is this building 50 years of agO or re? ❑ Yes ❑ No If yes, you may need to contaitHistorfcPr selvatlon If this is for a demolition peolt, wriat year was the building constructed? if prior in 1975, you will need an assessment to submit WM dils application. of work v— T " l *If lawn sprinkler/badcflow pre+ter, triust list licensed plumber. If first-time A/C, must list licensed el 'clan. Subcontractors: List bye Comphny na a or City Of CO/lI175 /fcense 9 AkV L6e�- Electrician Plutpber Mechankaal Roofer Other I hereby acknowledge that I havg read is application and state that the above Information is complete and correct I agree to comply with' all requirements contained 1herein and cky ordinances and state laws regulating building construction. I Imow that a permit is not valid until it has beel paid and issued. Print Name. _ i - Signature `rru,5T Nccourl+