HomeMy WebLinkAbout4448 Stoney Creek Dr - Applications/Reroof - 09/02/2011Sep 02 11 10:21 a Atlas Roofing 1 9702661821 p.1
City of
F6rt Collins
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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) O Electrical Alteration (not service change) O Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement40oofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicabblle, information on the application. Incomplete applications will not be accepted.
Application wig Date
For office use only
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Otue of Constnt ion (labor, materials, prat)
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Applicant Name
Address IJ
City/State Zip Phone
Contractor
Address
City/State Zip *o 7
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Contractor City of Ft Collins
Tax #4
Are you paying taxes here or by report -mid -mere ❑ Report
Sales tar number isrequiredbyall con"cras
Are you paying with your trust account es ❑ No
Is this a residential or copmnercial project? ETResidential ❑ Commercial
If residential, is it: Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar O Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ other (explain)
Is this building 50 years of age or more? O Yes �96o If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Ifpnor to 1975, you will need an asbestos assessment to submit with this app/iratron.
*If lawn sprinkler/badcflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name orCity ofRCofGnslicense #
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. r
Applicant ODb _1Octi r) Signature Date
Print Name: VL
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