HomeMy WebLinkAbout2325 Moss Rose Ln - Applications/Reroof - 11/09/2017This application is to be used to apply for the following Permits only (check all that apply0 Air Conditioning
❑Gas Lightee
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) r CI Gas Log
❑ Heating onit❑ Water Heaterk0r0 Mobile Water lane"orne replacement 13 Roofing ❑ Wood/Pellet Stove (must be E❑PA certified. Pro de makeSewer Line 0 ! model and
❑ Ventilate
manufacturer).accepted.
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Complete all applicable information on the application. Incomplete aPPlica4ions will not be acCePte �� Or-T
licaton # t)o o-j-ni
APP For office use only
lob site Address. (required)
Property owner Name
Name
Contractor
Date
Value of Construction (labor, materials, profit)
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Address City/State
Address City/State,
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Address Gty/State
Contractor City of Ft Collins Sales Tax #
Sales lax number is requked by all mnbaMrs
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Zlp Phone
Zip MUM
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Zip Phone
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Are you paying taxes here or by report? %Here ❑ Report
Are you paying with your trust account? Yes ONO
Is this a residential or 05in
al project? Residential [I commercial ❑Duplex
If residential, is ite Family Detached ❑Condo/bownhome (single family attached)
family (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar 0 Church Hotel/Motel 0 Medical office 0 Office RIII
❑ Restaurant ❑ Other (e)cplain)
Is this building SO years of age or more? ❑ yes 0 No If yesy you may need to contact lfistonc Pr+�servatlon
If this is for a demolition permit, what year was the building constructed? _ r-
Description of work
* rinkler/bacldtow preventer, must list licensed plumber
If first-time A/C, must fist licensed electrician.
If lawn sp
Subcontractors: List the company name or Gty of ft Collins license +� Roofer Other —
Electridan�--
Plumber�— Me&artlml —
I hereby acknowledge that I have read this application and state that the above information is complete and correct I agrethat e to
comply with all requirements contained herein and city ordinances and state laws regulating building construction. II knowa
permit is not valid until it has been paid and issued.
Applicant: date
Signature
Print Name:
RWS[cn data 2NM17