HomeMy WebLinkAbout700 Pear St - Applications/Reroof - 11/16/201511/12/2015 10:00 19702241211 ROCKY MTN ROOFERS PAGE 01/01
City of
F o Collins
Planning, Development a Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fag 224-6134
OVER-ll'HE-COUNTER PERMITS ONLY
This application is to be used te apply for the following parmits only (chock all that apply). ❑ Air Conditioning
❑ Demolition (interior non-structu I) EI. Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement KRoofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line 13 Wood/Pellet Stove (must be EPA certified,: provide make, model and
manufacturer).
Complete all applicable Informs don on the application. Incomplete applications will not be accepted.
Application # Date 11 l S
Farms im only
lob Site Address (required)
Value of Couction Qabor, materials, profit)
m�
-loo
.I (Pv
Property Owner Name
Address
City/State Zip
Phone G'40
a
. �8a
ApplicanAame
Address
City/State Zip
Phone
Contractor —t� ''
Address
G/Sbe ipRpeV.&+0.
Phone
rdrs C"#j
5 5.1� 4- � c c�
a � 1.
Contractor City of Ft Collins Sales
Tax # a 134L(o
Are you paying taxes here or by report?
❑ Here i[ Report
sae sfor rxnrrder&/KU&Wbyaaviba
Are you paying with your trust account?
Ali Yes ❑ No
Is this a residential or commercial p ject? 91 Residential CI Commercial
If residential, is it:, IN Single Fami y Detached 0 Condo/tnwnhome (single family attached) 13 Duplex
0 Multifamily I apartment) [3 Garage
If commercial, is it: 13 Bank r 13 Church ❑ Rotel/Motel E3 Medical office ❑ Office .17 Retail
Q Restaurant 13 Other. (explain)
Is this building SO years of age or re? EIYes A No If^ yeu mW1?eed to mnta[t H&Wdcpr�don
If this is for a demolition permit, at year was the building constructed? Kit)
0priorto,1975, you. wilt nehed an asTa5rcs assessment to submit with this epp1k- 0—& n.
Of
(t Vu-s = - =) o IF rgo*e
*If lawn sprinkler/baddlow preventer, must list licensed plumber. If first*time A(C, must list licensed electrician.
Subcw*ractors: List the company ire Or Gty ofFt Coffins /item p
EkWidan Plumber
I hem* acknowledge that I have
comply with all requirements cola
permit is not veHd until it has
Applicant; t~
Print Name:
Mechanical Ruder
Other
this appIkation and state that the above information Is complete and correct. I agree to
herein and city ordinances and state laws regulating building construction, i know that a
paid and issued.
signature ,,_,�h ��� Date �, • 1 S