HomeMy WebLinkAbout708 E Stuart St - Applications/Reroof - 03/13/2013Mar.13. 2013 12:54PM Roof Works, LLC
No. 900E
City of
pool t Collins -
Planning, Development & Transportation
281 N. College Ave P.O. Box S80
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
Q Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement X-Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer)- q
Complete all applicable information on the application. Incomplete applications will not be accepted. 1O
Application # i��3D l_l1 -. _ Date 2l 1 Z;l 113
For office use only
Job Site Address (required)
Value, of Construction (labor, materials, profit)
`10 S F 5-r-oA0-"-r ST,
U
Property Owner Name
Address
City/State Zip
Phone
Applicant Name
Address
Gty/State ZIP
Phone
`�r2 Ol
CA�T
T A J'q0 ti . Ca) 9o2A 1
303 '>s3. 1 r7-S
Contractor
Address
City/State Zip
Phone
ROOF a tz'r, IL961
,4rn
ftn N 816241
303-358. 18z5-
Contractor City of Ft. Collins Sales Tax
#
Are you paying taxes here or by report?
❑ Here ❑ Report
Sales tax number /srequ/red by al/contractors
Are you paying with your trust account?
❑ Yes V No
Is this a residential or commercial project? la Residential ❑ Commercial
If residential, is it: M Single Family Detached ❑ Condo/townhome (single family attached) Q 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 Ifyes, youmayneedto contact HistoricPreseruation
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 With this appllcatlon.
J illA-'&" I k19 S c * •M
*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 Collins license #
Electrldan Plumber Mechanical Roofer,Q—Zlfy— 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 reguladng building construction. I know that a
permit is not valid until it has been paid and issued.
Applicant: —
Print Name: ( Wr m AA i UJX. Signature �J> �� Date ! 3