HomeMy WebLinkAbout3920 Century Dr - Applications/Reroof - 08/25/201108/22/2011 15:02 9703305645
City of
fort CoWns
SLAUGHTER ROOFING
PAGE 02/02
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). O Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater Cl Water Line O Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information conntthe application. Incomplete applications will not be accepted.
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Application * Date
For office use only
Job Site Address (requned)
Value of construction (labor, materials, profit)
Z 600
Property Owner Name Address
City/State Zip Phone
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Cow 223- 0
Applicant Name Address
City/State Zip Phone
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Contractor Address
City/State Zip Phone
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? P4 Here ❑ Report
sates raxnumber isrequ/red byall mnmcrois
3�ro53
Are you paying with your trust account? 0 Yes ❑ No
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Is this a residential or commercial project? 0 Residential ❑ Commercial
If residential, is it: IR Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) O Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building So,yearsof age or more? ❑ Yes j) No if yes, you may need to contactH/storicpieservatlon
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/icaGon.
Description of work
*If lawn sprinkler/bacldiow preventer, must list licensed plumber. If First-time A/C, must list licensed electrician.
Subcontractors: list the company name or Co, of Ft Coll/ns license /
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.
Applicant:
Print Name: ( /Pt�A (�� �lX��i 1.� Signature
Date—