HomeMy WebLinkAbout3500 Rolling Green Dr - Applications/Reroof - 11/02/2015 (4)City of
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Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
MT FARQN-MuRd
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 service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing El Sewer Line ❑ Photo -voltaic
❑ Ventilation El Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer). 5(�
Complete all applicable information on the application. Incomplete applications will not be accepted.
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Application # �) 1 ��)6 Date
For office use only
Job Site Address (required) '�l �_3
Value of Construction (labor, materials, profit)
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Property Owner Name,} Address
City/State
Zip
Phone
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8os�y
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Applicant Name Address
City/State
Zip
Phone
Contractor Address h
City/State
Zip
Phone
Contractor City of Ft. Collins Sales Tax #
Sales tax number isreouiredbyall contractors.
Are you paying with your trust account? ❑
Yes kNo
Is this a residential or commercial project? Wesidential ❑Commercial
If residential, is it: ❑ Single Family Detached Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ other (explain)
Is this building So years of age or more? ❑ Yes _S� No 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.
Description _ of work6'r
*If lawn sprinkler/backllow preventer, must list licensed plumber. If first-time A/C, must list li ensed 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: I
Print Name: r(� M «� l�lOje Signatur Date