HomeMy WebLinkAbout627 ROMA VALLEY CT - APPLICATIONS - 9/9/2011Sep 09 11 04:19p Gold Roofing, Inc.
9705930124 p.1
City of
�F6rt Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
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 0 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 # i� �:' I l(,4ga`o Date e,
For office use only I S 9_�
Job Site Address (required) Value of Construction (labor, materials, profit)
Property Owner Name Address
City/State Zip
Phone q )G
Applicant Name Address
City/State Zip
Phone ci C
Contractor Llc # Address
City/State Zip
hone
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by repo rHere
❑ Report
Sales tax number is required by all contactors.
Are you paying with your trust account? Yes
Yes
❑ No
Is this a residentiaNr`commercial project? ❑ Residential ❑ Commercial
If residential, is it: `111 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? O Yes ❑ No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit witfi this application.
Description of work
I IV'-e X t� )
*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 Collins license N
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.
Applicant: ,
Print Name: A(R I �C�� GEC. Signature rr-- Date U r1 - QC1— j