HomeMy WebLinkAbout3007 ROCKBOROUGH CT - APPLICATIONS - 9/22/2011SEP-22-2011(THU) 09:31 15.001/001
Planning, Development & Transportation
City, 281: N. College Ave P.O. Box 580
�O� ` C�«ihlS Fort Collins, CO 80524
Phone 070-416-2740 ' Fax 224-6n4
OVER-THE-COUNTER PERMITS ONLY
Phis application Is to be used to apply fat tho following permits only (check all that apply). . oning
Demolition Anterior non-structuran Electrical Alteration (not service change) Gas Lighter Gas Log
Heating Unit Lawn Sprinkler Mobile Home replacement Roofing Sewer Line Photo-v
Ventilation . Water Heater Water Line Wood/pellet Stove,(must be EPA certified, provide make, model and
manufacturer).
Complete all appy bie Information on the application, Incomplete applications wi.11 of be accepted
J
Application # o
' - Date -
AV Dam M only
Is this a residential or s1-projee iden��wnhome
Commercial
If re sidaltlal, is It �S�Inleamil Detached (single family attached) Duplex
Multlfamlly (apartment) Garage
If commercial, is It. -- lank Bar Church Hotel/Motel Medlenl orrice Office Retall
Restaurant Other (explain)
Is this building So years of age or more? Yes No Ily% you rrayneed to cantactHlsterk prose varnon
If this Is fora demolition permit, what year was the building constructed?
Ilpriorto 19iS. you willnecdan ads as ="r cn sub"dt with this app/kaDon. _
Description of
*!F lawn sprinklcr/backflow preventer, must list licensed plumber. if 0 ,rdme A1C, must, list Ilmnsed eleet6dan.
Subcontractors~ L&r die Company rame Ar O?y ofA' Collin license f
ElealaWLEL i Plumber. - -- Mechanleal Roofer. ... Other
I hereby acknowledge that: I have redd,this application and state that the above Information Is complete and correct. I agree to
comply with all raqulrements contained herein and city ordinances and SMte laws regulating bullding eordtrucdon. -know that a
permit is not valid until It has been paid and Issued.
Applican (�
Print Nam Signature,t,,t_ Date 1