HomeMy WebLinkAbout556 Kim Dr - Applications/Reroof - 08/18/2011Aug 1711 12:09p Schroeder Roofing
970-669-3532 p.3
Fort Collins
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) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement 0 Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation 0 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 # A-1-0'� Date / IU20I
r aFfrce use only use
lob Site Address (required)
Value of Construction (labor, materials, profit)
556 Kim Dr
2300
. Property Owner Name Address
City/State Zip
Phone
Lagumbay, Randy 556 Kim Dr
Ft Collins 80525
227-5645
Applicant Name Address
City/State Zip
Phone
Schroeder Roofing. Inc 1300 N Monroe Ave
Loveland, CO 80537
970-667-6777
Contractor Address
City/State Zip
Phone
Schroeder Roofing, Inc 1300 N Monroe Ave
Loveland, CO 80537
970-667-6777
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
0 Here ❑ Report
Sales tax numberisrequiredbyallmnbaca77s.
Are you paying with your trust account?
0 Yes ❑ No
41047
Is this a residential or commercial project? 0 Residential ❑ Commercial
If residential, is it: 0 Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ HoteliMotel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No If yes, you may need to contact H6toric Preservation
If this is for a demolition permit, what year was the building constructed?
Ifprior to 1975, you will need an asbestos assessment to submit with Mis application.
Description of work Remove existing roof, install all needed flashings, felt, shingles.
*If lawn sprinkler/backftow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
1
Subcontractors: List the company name or City of Ft Ccllins iirnnse
I
Electrician Plumber Mechanical Roofer R-1408 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: Brian Hill
i Digitally signed by Brian Mill
/d•,.j:. ""' Date: 2011.06.1711:53:a7
Signature 46ro0 Date 8117A 1