HomeMy WebLinkAbout4249 FALL RIVER DR - APPLICATIONS - 9/25/201409/25/2014 11:20AM FAX 3034200987
PROFESSIONAL ROOFING
IA0002/0003
City of
ort Colll�s
Planning, Development 8k 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). C3 Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) d Gas Lighter ❑ Gas Log
n Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing O Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater C1 Water Line ❑ Wood/Peliet Stove (must be EPA certified, provide make, model and
manufacturer),
Complete all applicable Information on the application. Incomplete applications will not be accepted.
Application # N L—I D q E�> I Date ql am
Par a ffm use arty
Job Site Address (mquima)
Value of Construction (labor, materials, profit)
Property Owner Name Address
(Sty/State Zip
Phone
r
Applicant hame Address
City State Zip
--Wdh:e
Contractor Address
/State Zip
Phone
Contractor City of R. Collins Sales Tax #
Are you paying taxes here or by report?
0 Were ❑ Report
s2rar&xnumber&MgL dbyasmntracftM
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or mmercial project? Residential D Commercial
If residential, is it: Single Family Detac O Condo/townhome (single family attached) CS Duplex
Multifamily (apartment) ❑ Garage
If commercial, is it: O Bank O ear El Church O Hotel/Motel ❑ Medical office O Offlce 0 Retail
❑ Restaurant ❑ Other'(e in)
Is this building 50 years of age or more? O Yes No tfyesy ylvu may wed to contact HWork Pmervatfon
If this is for a demolition permit, what year was a building constructed?
Ifprfor to 1975, Mu w#1 need an asbest it assessment to submit Wffi this appl/cadon.
*If lawn sprinkler/back iow preventer, must list licensed plumber. If first-time A/C, must list licensed electiiclan.
SubcontraCtoraa List the company name or dry of ft CWIns I/tense #
Electrician _�_ Plumber Mechanical Rooter
Other
I hereby acknowledge that I have reed 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.
Applicants
PMnt Name:Signature Oate
V.