HomeMy WebLinkAbout754 Rocky Mountain Way - Applications/Reroof - 08/30/2017Fort Collins
Planning, Development ® Transportation
281 N. College Ave P.O. Box 5B0
Fort Collins, CO 80524
Phone 970-416-2740 Fax 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 service 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 # b t Date ESP:
for oArae use only
lob Site Address (required)
Value of Construction (labor, materials, profit)
Property Owner Name Address
City/State Zip Phone
Applicant Nam�ee Address 101,
Zip Phone-�
7�Ci,ty/State
vV Ai /� GLi �V
Contractor Address
Oty/State ZIP Phone
/
Contractor City of R. Collin les Tax #
Are you 6ying taxes here or by report? ❑ Here krReport
Sales tar fwn;&rlstwWredbya#cunbaclars.
Are you paying with your trust account? ❑ Yes �WNo
Is this a residential or commercial project? XResidential ❑ 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 50 years of age or more? Cl Yes O No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed"
1f prior to 1975, you will need an asbestos assessment to submit with this application.
Description of workF4 OWY eg. ' % '
." I '
*if la sprinkler/backfiow pr, enter, must list licensed plumber. first-time A/ , must list licensed electrician.
Subcontractors: List the company name or Oty of R Collins 1wense e
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.
AppliceM:
Print Name: G��/ ' "' �-s signatureDate v /�
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