HomeMy WebLinkAbout311 S College Ave - Applications/Reroof - 06/02/201506/02/2015 09:56 19
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ROCKY MTN ROOFERS
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City Of
FrtCodins
OVER=
This application Is to be used to
0 Demolition (interior non-structur
❑ Heating Unit ❑ Lawn Sprinkler
p Ventilation ❑ Water Heater .❑ h
manufacturer).
Complete all applicable informal
Application # 1❑�
For ofike W.on/y
Sob site Address (mquftV
Property owner Name
Applicant Name
kContractor
641A.'A%NLQ0 +jc:..o y
�,-� � C�u tk•�r-a
Contractor City of R. Collins Sales
Saks caK number'xs rpquledbrall Nnbac
Planning, DeVeloprttent & TraAWrtaltion
281 N. College Ave P.O. Box 58D
Fort Collins, Co 80524
Phone 970-416-2740 Fax 2246134
HE -COUNTER PERMITS ONLY
pply for the following permits only (check all that apply). O Air conditioning
i L] Electrical Alteration (not service change) ❑ Gas Lighter O Gas Log
7 Mobile Home replacement Roofing ❑ Sewer Line ❑ Photo-vottwc
rater Line O Wood/Pellet Stove (must,be EPA certified. provide make, model and
m on the application. Incomplete applications will not be accepted.
Date L9�1
Value of Construction.(kabor, materials, profit)
vo
r... Address city/stem Zip Phone 1.�3
Address City/State Zip Phone
Address City/State Zip Phone4'10
6L Sso�l a _raa�
rax # LI 13 (v Are you paying taxes here or by report? ❑ Here A Report
wx Are you paying with your mist account? 0 Yes 0 No
Is this a residential or commercial p�Dject. ' O Restdentlat 0 Commercial
If residental, Is it: 0 Slhgle Fami Detached 13 Condo/townhome (single family attached) O Duplex
❑ Multifamily apartment) 0 Garage
If commercial, is it: C] Bank -0 r O.Church ❑ Aotel/Motel O Medical office ❑ Office ■ Retail
O Restaurant Q other (explain)
Is this building So years of age or ore? ❑ Yes ■ No If yes, you may ae�a to contact Htstorlc Preservation
If this Is for a demolition permit 1 ftt year was the building constructed? i..ro
,lfpriar to 1975, you wi//need an assewmh1tto submit wzi ffiis apo/%ation.
Description of
*If lawn sprinkler/baditw prgvenber, must list licensed plumber. If first -turd AA must list licensedl electrician.
subcontmeors: List ebecixwny n ww irO?yofFtCOINrsnc+erw0 R�c�.-e•.��-`it-� n•-'a"- 2`)'"tlao�`�' t"J
Plumber- Mechanical Roofer Other
I hereby admowledge that I have req this application and state that the above information is complfe and correct I agree to
comply wab all requirements =ntalnep herein and city ordinances and state laws regulating budding construction. I know that a
permit is not valid unM it%as pall and Issued.
.
Applicant: D ! J �� 4/L Signature Dale �0
Print Name' •`� . I
Tr tg,� IAGCACUre-I A_