HomeMy WebLinkAbout6244 ROOKERY RD - APPLICATIONS - 3/27/2019C„I't�t i7o
This application is
❑ Demolition (interi
Heating Unit ❑
❑ Ventilation ❑ m
manufacturer).
Complete all applic
Application '# 131
For of
Job Site Address (re
9rmce "I ImA r
Property Owner Name
Applicant Name
Contractor
Contractor City of Ft: C
Planning, Development & Transportation
281 N. College Ave P,O, Box 580
if Fort Collins, CO 80524
Phone 970.416-2740 Fax 224-6134
FER-THE-COUNTER PERMITS ONLY
used to apply for the following permits only (check all that apply). XI Air Conditioning
)-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
Rater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
information on the application, Incomplete applications will not be accepted.
Date ___�19-7 ) �
ise only 3 bC�)g 7�I -
Pi
Sales Tax #
contractors.
Value of Construction (labor, materials
{�• (At"
� , profi ,43y.
.UO
Pint Co 61,(,n �(LXD528 �i�a leg2-3873 _
Addres City/State Zip Phone
-ockheec( Ate. Lov I to +m - qqq a_
Address City/State Zip A . , Phone
—
Address City/State
zip i Phone
Are you paying taxes here or by report? ❑ Here Report
Are you paying with your trust Iiccount? , Yes ❑
Is this a residential or c ercial project? Residential E7 Commercial
If residential, is it: i' Ile Family Detach d ❑ Condo/townhome (single family attached) ❑ Duplex
I u :ifamily (apartment) 0 Garage
If commercial, is it: ❑ I <i" k 0 Bar ❑ Church L7 Hotel Motel ID Medical office ❑ Office ❑ Retail
❑ F e aurant EJ Other (ex lain)
Is this building 50 years i; age or more? O Yes No Iryes, you may need to contact Historic ion
If this is for a demolitioi ' armit, what year was the uilding constructed? _
If prior to 1975, you will, "e" clan asbestos assessment' to submit with this application.
Description of work WON, 4IXP IA a. a VIA 17�A nA i1 1n iY 4nTs- _
*If lawn sprinkler/backflov
Subcontractors; l_istthe
I hereby acknowledge that
comply with all requiremen
permit is not valid until
Applicant:
Print Namei/
r, must list licensed plumber. If first-time A/c, must list licensed ele
name or City of Ft Coll/ns l/tense #
Mechanical__ Roofer
— Other
read this application and state that the above information is complete and correct. I agree to
ained herein and city ordinances and state laws regulating building construction, I know that a
been paid and issued.
Signature
Date