HomeMy WebLinkAbout221 Jefferson St - Applications/Reroof - 11/29/2012Nov•28. 2012 3:32PM ADVANCED ROOFING
No,5502
FCilirt 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 0 Gas Log
0 Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement i7 Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation C] Water Heater ❑ Water Line El Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable Inf rynation on the application. Incomplete applications will not be accepted.
Application # 12) 1 ,C?0-1 10 3
For oii5te cage only
Date 1112-111Z, 11 `a 9
Sob Site Address (required) ,'
Value of Construction (labor, materials, profit)
a7 ZI-Z-
P rty Owner Name
Address City/State ZIP hone 0—
Appf Name
Address City/State .Zip Phone
Contractor
Address Gty/State Zip Phone
..
Contractor City of FL Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
SaAuiaxnronberb ,red aticnvlbacmrs
Are you paying with your trust account? JR 'e ❑ No
Is this a residential or commercial project? ❑ Residential Commercial
if residential, Is It: ❑ Single Family Detached ❑ Cando/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotal/Motel ❑ Medical office W-0mce �*daill
❑ Restaurant ❑ Other. (explain)
Is this building 50 years of age or more? EI Yes V�6 IfM, you mayncei to contact Histolic PrE seneVon
If this is for a demolition permit what year was the building constructed?
Ifori[ir lb I975,,1� wi!/n�1 �R d�i�s'�Aet tQ sulttitltW+4t+ this appl/raaabrt.
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*If lawn sonkler/baciftw
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Subcontractors: 4& the car>wnynarm or City arFtCoin /ica° w #
must list licensed etectridan.
Electric n ...... Plumbed MeehOniral---- ^^ Roofer Other
I hereby acknowledge that I have read this application and state that the above Information is eomptfe 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 vaNd until It has been paid and MUM.
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