HomeMy WebLinkAbout3281 ROOKERY RD - APPLICATIONS - 3/21/2019City of Planning, Development, & Transportation Services
Flirt Collins Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main: 970.416.2740 Fax: 970.224.6134
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 9 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 # '6190114
For office use only
Date 03/21/2019
Sob Site Address (required) Value of Construction (labor, materials, profit)
3281 Rookery Road $10717.76
Property Owner Name Address City/State Zip Phone
Dave Offerman 3281 Rookery Road Fort Collins, CO 80528 303-881-5689
Applicant Name Address City/State Zip Phone
Anastacia Rodriguez 3780 N Garfield Ave, Ste 105, Loveland, CO 80538 970-660-4417
Contractor Address City/State Zip Phone
Denali Roofing, LLC 3780 N Garfield Ave, Ste 105, Loveland, CO 80538 970-660-4417
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ® Here ❑ Report
Sales tax number is required by all contractors Are you paying with your trust account? 19 Yes ❑ No
3587-R+
Is this a residential or commercial project? ® Residential ❑ Commercial
If residential, is it: Ed 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? ❑ Yes ❑ No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work Remove and replace with GAF Timberline Armorshield II- Class 4 IR shingle
130MPH/20Y/42 squares
*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 #
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: Anastacia Rodriguez Signature R)ilr(. tf ez Date 03121/2019
Revision dale 216 2017