HomeMy WebLinkAbout518 Flagler Rd - Applications/Reroof - 10/05/2011Oct 0511 10:53a A J Shirk Roofing 19706695999 p.1
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FCfC�/Of �. D V� lei inC4 Planning, Development &Transportation
281 N. College Ave P.O. Box 580
F6rt �O S3-7 Collins Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
its 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 . ❑ Lawn Sprinkler ❑ Mobile Home replacement 0oofing ❑ Sewer Line ❑ Photo -voltaic
Ventilation ❑ Water Heater ❑Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
all applicable information on the application. Incomplete applications will not be accepted.
# //0 2 �!
For orrice use only
Date
lob Site Address (required)
Value of Consbu:don (labor, materials, profit)
05'l F(kyr 12d
Property Owner Name Address
City/State Zip Phone
4Cc)
JeSUS 1 anne -5t9 Flaqier
- FC (dgj.03170
Applicant Name Address
City/State Zip Phone
-� Shirk d 00-Ftvr
Contractor Address
City/state Zip Phone
3, 'r o FI h Say E.
lo''ST Ia, d o 8os37 �'�° 9
tractor City of Ft. Collins Sates Tax # Are you paying taxes here or by report? ❑ Here ,i Report
y/ O 3
estax number isrequiredbyaffcwro-actvm.
Are you paying with your trust account?, Yes ❑ No
this a residential or commercial project? b(Residential ❑ Commercial
f residential, is it: dSingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
f commercial, is it ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
s this building So years of age or more? ❑ Yes ❑ No bryes, you may need to contact Historic preservation
f this is for a demolition permit, what year was the building constructed?
f prior to 1975, you wi// need an asbestos assesvnent to submit widr this application.
of work
lawn sprinkler/backflow preventer, must list licensed plumber. If rust -time A/C, must list licensed electrician.
xontractors: list the company name or City ofFt collins license ? R 15e?
Plumber Mechanical Roofer _><- Other
hereby acknowledge that I have read this application and state that the above information is complete and correct I agree to
Imply with all requirements contained herein and city onderances and state laws regulating building construction. I lmow that a
ermit is not valid until it has been paid and issued,
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