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HomeMy WebLinkAbout1024 Davidson Dr - Applications/Reroof - 05/27/201505/27/2015 10:03 19702241211 ROCKY MTN ROOFERS PAGE 01/01 -(�.�' Planning. Development & Transpotteti0n city C�f"'►�[ pp '�„ oil k\ � ` 251 N, College Ave P.O. Box 580 , Fort Collins, CO 80524 i Phone 970416-2740 Fax 22"134 •OY W H.E-COU, LATER PERMITS ONLY This application is to be u ted to ppttr for the following pennlfs only (check all that apply). 0 Air Conditioning ❑ Demolition (Interior non-9 ructurs). ❑ Electrical Alteration .(riot service change) ❑ Gas Lighter O Gas Log ❑ Heating Unit Cl Lawn Sj rinkler ZI Mobile Home replacement loafing ❑Sewer Line 0 Photo voltaic ❑ ventilation 13 Water Hea or. ❑ V Fater Line 0 Wood/Pellet Stove (must be EPA certified, provide make, model and manufacturer). Complete all applicable I ormatl n on the application. Incomplete applications will not be accepted. 70 v Date • 1 Application # only For o1 Job Ske Address (rcq Value of Construction .(laltor, materials, profit) (J .. sv C r Ury 6 Property Owner Name Addnss City/State Zip Phone G a �a3 3 3 Applicant Name Address City/State Zip Phone # Contractor 7 1 IFS — •Address citY/eta Zip Phone4'1 '0 Contractor City of Pt. Collin Sales ax # N 1.5 *(o Are you paying taxes, here or by report? ❑ Here Reportyy Are you paying with your trust account? 41 Yes © No Is this a residential or cam If residential, is it: Sin ial p le Fami ect? 0 Residential • O Commercial Detached 0 Condo/bownhome (single family attached) 0 Duplex O Mu famiy apartment) E3 Garage If commercial, is It; 0 Ba 17 r ❑•Church O Hotel/Motel O Medical office O office C3 Retail 0 R 'rant O other (explain) Is this building SO yeprs of .age or ore? E3 Yes IS No If yes, yourtrayneed to conceit H4-; dC Preservation If this is for a demolition It. at year was the building constructed? if prior to 1975, you W11 anas esms aasament to subn* WO this app/kaaron. Description of worlc`T.c e S kS vf'L-_f pip Xk7y *If lawn sprinkier/baddiow p enter, must list licensed plumber. if firstrtim MC, must list licensed electrician. Subaantiacborin 14t Me ca 77panyn or OW DFIT Cdkw hawse 0 A\`rCLC4A.�6j Hlectridan Plumber t+tedlenl®I RAtlfar Other I hereby adohnwledge that I ave reai i this application and stage that the above bhfnrmation is complete and corret4 I agree to comply with all requirements cordaineJ herein and city ordinances and state laws regulating building construction. I imow that a permit is not valid until it has b6e n paid and issued. ApplicwiU5 t" 9 %! Date � � Pdnt Name: Signature