HomeMy WebLinkAbout4219 Fall River Dr - Applications/Reroof - 11/21/201411/1.0/2014 4:39PM FAX 3034200987
For � :ouins
PROFESSIONAL ROOFING 160001/0001
Planning, (Development rlk Transportation
281 N. College Ave P.O. Box Seo
Fort Collins, OD 80524
Phone 970-416-2740 Fax 22+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) 17 Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement 0 Roofing ❑ Sewer Line ❑ Photo-volteio
❑ ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable Information on the application. incomplete app110ations will not ba aaeanmd.
Application# 6
ftWea Low on/y
Address
Contractor City of Ft, Collins Salg Tax #
Soft tax numbw&re diedbyallawbaarff'
Date / c2Z/- 4 4135 -4
Value of
Zip
PIN
Are you paying taxes hbre or by report? ❑ Here � Report
Are You paying with your trust account? 0 Yes 0 No .
Is this a residential or coal project? 01<1dential ❑ Commercial
If residential, is it: J12SIngle family Detached 0 Condo/townhome (single family attached) Q Duplex
0 Multifamily (apartment) ❑ Garage
If commercial, Is it: O Bank' 0 Bar p church C) Hotel/Motel G Medical office ❑ office ❑ Retail
O Restaurant 17 Other (explain)
Is this bullding SQ years of age or more? ❑ Yes Q No y)W yar/ nayynead to =,act H&to* pmJWm9t/017 If this Is for a denlolitlon pern*, what year was the bullding constructed?
ffp»ar tv 1974 you W11 need an asbeAw asw� m mant tv submit g77Yr th/s ®pp/icadon.
Description of
-ir lawn sprinvier/eaCMlow pieventer, must Ilst licensed plumber. If first-tlme A/C, must Ilst Ikensed
SubconbeCtore: L/attdre Cvmplanyname av Lily OfRCo//rnsffmWV p
Electrldan_ _, Plumber Mechanlrel
Roafer. pther
I hereby acknowledge that I have mad 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
parrrilt It. not valid undi It IM been paid and Issued. '
-10 I