HomeMy WebLinkAbout325 E Saturn Dr - Applications/Reroof - 10/08/201110/07/2011 10:46 9703305645
City of
rt C di.. h
SLAUGHTER ROOFING
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
PAGE 06/07
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 Q Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing Q 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 #�' 110 c �t Date ��� d H,
For olFice use bn1v
Job Site Address ftqulmd)
Value of Construction (labor, materials, profit)
2
415C0,00
Property Owner Name Address
City/State zip Phone
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Applicant Name Address
City/State Zip Phone
Contractor Address
City/State Zip Phone
Zao C o%
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Contractor City of R. Collins Sales Tax #
Are you paying taxes here or by report? ;K Here ❑ Report
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Are you paying with your trust account? Mi Yes ❑ No
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Is this a residential or commercial project? $I Residential ❑ Commercial
If residential, is it: IX Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
E3 Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar O Church ❑ Hotel/Motel ❑ Medical office ❑ office ❑ Retail
O Restaurant ❑ Other (explain)
Is this building SO years of age or more? ❑ Yes )O No If yes, you may need to contact H&oiic Preservation
If this is for a demolltion permit, what year was the building constructed?
If prior to 1975, you will needan asbestas asswment to submit witch thls application.
Description of work
*If lawn sprinkler/backflow preventer,, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Ust the company name or Oty of Collins license ,a
Nedilden Plumber Medhaninl 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; Signature Date 0