HomeMy WebLinkAbout3806 Rochdale Dr - Applications/Reroof - 09/11/2014Sep 11 1411:21a Tony
1-970.669-5999 p.6
Fort Col[ins
Planning, Development & Transportation
281 N. College Ave P.O. Box s8o
Fort Collins, CO 80524
Phone 970 416 2740 Fax 224-6134it ( 4�-7,'T,5
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 ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable Information on tth)e application. Incomplete applications
%will not be accepted:
Application # lel � � s-1v`�
Date
For office use only
Job Site Address (required)
3g�t� K
DZ.
Value of Construction (labor, materials,
profit)
Property Owner ame
Address
City/State Zip
Phone q�Q
Applicant Name
Address
City/State Zip
PhoneOs+bltm}
I:Contractir
CQ fl7 -
7 9
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Address
City/State Zip
Phone
S n
p iv
1,,it1fr6 kki AU401-Lb ki;
Con r-actor City of Ft. Collins sales ax #
Sales tax numbarisrequredbya#contractors.
Are you paying with your trust account? Yes
❑ No
Is this a residential or commercial project? Residential ❑ Commercial
If residential, is it: XSlng,le Family Detached 17 Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office Li Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes C�No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Ifprror to 1975, you W11 need an asbestos assessment to submit with this apollcab'on. -
cliption of wo ma '
n
If lawn sprinkler/baddiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: tlst the company name or city of Ft Collins ilcense
Electrician Plumber Mechanical Roofer Other
I hereby acknowledge that I have read this application and state that the above information is complete and correct. I agree to
comply with all requirements contained herein and city ordinances and state laws regulating building construction. I know that a
permit is not valid until it has been paid and issued.
Applicant:
Print Na Ua l Si atu Date