HomeMy WebLinkAbout724 Rochelle Cir - Applications/Reroof - 10/06/2014✓3i9q-7
City of Planning, Development & Transportation
281 N. College Ave P.O. Box 580
F61r} l Collins IS Fort Collins, CO 80524
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 servlc hange) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement oofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applica le information on the application. Incomplete applications will not be accepte f�
Application # 06�41X Date /a/6AL4
For o>fce use only
lob Site Addres (required) /1 t Value of Construction (labor, materials, profit)
Property Owner Name
Address
City/State Zip Phone
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Applicant Name
Address
City/ tate Phone
Zip
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Contractor Lic #
Address
City/State Zip Phone
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Contractor City of Ft. Collins Sales Tax
Are you paying taxes here or by report? dKere ❑ Report
sales tax number is required by all contractors.
Are you paying with your trust account? ❑ Yes U-Ne--l'
Is this a residential or co ercial project? DIResidential ❑ Commercial i
If residential, is it: Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/ el ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain
Is this building 50 years of age or more? ❑ Yes o If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license #
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 Name: MG 3OSSb _ Signaturef/y-�� J/ Date AN I
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