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HomeMy WebLinkAbout3005 Ross Dr - Applications/Reroof - 06/29/201506/29/2015 12:14 211 ROCKY MTN ROOFERS PAGE 01/01 City of OVER-1 This application Is to be used to ❑ Demolition (interior non4trtictun 0 Heating Unit ❑ lawn Sprinkler ❑ Ventilation Ca Water Heater O' manufacturer). Complete all applicable iriformat Application # �� 4 For a/ixie use only YI Planning, Development &. Transportation 281 N. College Ave P.O. Box 580 Fort Collins, CO 80524 Phone 970-416-2740 Fax 224-6134 NTER PERMITS ONLY apply for the following permits only (check all that apply). ❑ Air Conditioning 1) ❑ Electrical Ateration (not service change) ❑ Gas Lighter ❑ Gas Log O Mobile Home replacement KFloofing ❑ Sewer Line ❑ Photo -voltaic later Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and on the application. Incomplete applications will not be accepted. Date 6 . C;:l q . k 5 gee Address (req #m2 Sv Value of Construction. pabor, materials, profit) S nn Property Owner Name Address City/Stale Tip Phone QUO Applicid Name Address City/State ZIP • Phone RContractor TZ -t� bCL HVLaa 0-4 ArghttJ Address City/State Zip Phoneq*j© t�ao .rs F c"Ls Contractor City of Ft. Collins Sales ax # W.I 3 *(e Are you paying taxes here or by report? ❑ Here Ek Report SdES& rnUMber[rrequ/redayd#W1Wa '. Are you paying with your trust account? 44 Yes ❑ No is this a residential or commercial pp JeLr B Residential ❑ Commercial If residential, is It. O Single Famit Detached ® Condo/townhome (single family attached) 17 Duplex ❑ Multifamily ( partrrtent) O Garage If commercial, Is It: ❑ Bank O Ba 0 Church ❑ Motel/Motel ❑ Medical office ❑ office 0 Retail 13 Restaurant E3 Other (explain) Is this building 50years of age or r ore? 0 Yes ®No if yes, you rnayn"to cnntactliistovrc Preservation If this is for a demolition porr+eit, Ywhat year was the building constructed? d�' Ifprim to 1975, yrw w!I/ needdn a�srrenttn submit yddr bhls 8pplf-abb�L of work *If lawn sprmiclerrbaddiow preventer, Bubcontyactm. 4istdlP cvrimpanyn, Electrician Plumber_ t list licensed plumber. If first 6me`A/C, must list licensed elecbioan. orGlyormcc//lnsrlcem0 {�1,rrr✓.o.� rl�ar Zaci IrL Cr matt tieal Roofer Other I hereby admawledje that I have read this appllcation.and State that the above information Is Complete and Correct. I agree to comply with all requirements opntained herein and city ordinances and state laws regulating building construction. I know that a permit is not valid until R his been paid and issued. MMlca b To Al ` sigma j (Date - lD Q 1 r � Print Name:me: [.