HomeMy WebLinkAbout748 Rocky Mountain Way - Applications/Reroof - 08/29/2017City of Planning, Development, & Transportation Services
F`rt Collins Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main: 970.416.2740 Fax: 970.224 6134
OVER-THE-COUNTER PERMITS ONLY
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 services change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ® Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # 1 0C)490F] Date 21
For office use only
Job Site Address (required) I Value of Construction (labor, materials, profit)
Property Owner Na Address City/State Zip Phone
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Applicant Name Address City/State Zip Phone
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Contractor Address City/State Zip Phone
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Contractor City of Ft. Coll s Sales Tax # Are you paying taxes here or by report? Here ❑ Report
Sales tax number is required by all contractors. Are you paying with your trust account? ❑ Yes MINO
331559B3 -ooc) o
Is this a residential or commercial projects Residential ❑ Commercial
If residential, is it: ersingle 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 (exp�l )
Is this building 50 years of age or more? ❑ Yes L(No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work g g(L"
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*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collms license #
Electrician Plumber Mechanical Roofeo 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:7 � n2Y JU"X Signature Date 1 i/�l�—
Revision date 21612b17