HomeMy WebLinkAbout2613 Platte Pl - Applications/Reroof - 08/09/2011Aug 09 11 03:37p 5 Star Roofing Co.,LLC
970-663-7827 p.2
1-11ytIC 7/vT1V-L/TV 1'CA L4-['L1JT
THIE-COUNTER PERMITS ONLY
OVER -
This application is to be used to apply for the following permits only (check all that apply), ❑ Air Conditioning
❑ Demolition (interior non-structurao ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit 0 Lawn Sprinkler ❑ Mobile Home replacement 0 Roofing ❑ Sewer tine ❑ Photo -voltaic
0 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 # Date ��-' A
Paroxce ase only -7—�
Job Site
Applicant Name
Contractor Lic #
Contractor City of Ft. Collins Sales Tax #
Sales tax oulnoeris required by all cvatradam
Value of Construction (labor, materials, profit)
$ :� 4'�'y
Address
Oty/State
zip
Phone �A
Address
City/State
iip
Phone
Address
�3 �y�
City/State
6 ►5�. %il lur, 60
Zip
V0537
Phone
al --yjio
Are you paying taxes here or by report? 0 Here )A Report
Are you paying with your trust account? j( Yes ❑ No
Is this a residential or c mmeraal project? ❑ Residential ❑ Commercial
If residential, is it: 10 Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it- ❑ Bank ❑ gar ❑ Church ❑ Hotel/Motel ❑ Medkal office ❑ office ❑ Retail.
❑ Restaurant ❑ Other (explain)
Is this building So years of age or more? ❑ Yes ❑ No Ifyes, you mayneed to contactH&toik PreS&lVafon
If this is fbr a demolition permit, what year was the building constructed?
Ifpr/or to 1975, you will need an asbeslvs assessment to submit wldr this application.
Description of work
47 lawn sprinkler/backflow preventer, must Ilst licensed plumber. If first-time A/C, must fist licensed
Subcontractors: List the ronipanyname or Gty of Ft Collins license #
Electrician Plumber MedhanicaL. Rooter k fio Other
I hereby acknowledge that I have read this application and slate 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. n
Applicant -
Print Name: � r r'�Gc' ' (,YL�/ ; /� Signature AtiwDate
—cei(
1'IIy11C 7/U-T1V-4/TU 1'QA LLTTJ I../T
OVER-T E-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) O Gas Lighter ❑ Gas Log
O Heating Unit ❑ Lawn Sprinkler 0 Mobile Home replacement 0 Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation O 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 #�T,l��o� Date,
Foromce rise only
Job Site
Applicant Name
JYi.tr �c
Contractor ITC #
Contractor City of Ft Collins Sales Tax #
Sales taxnumberIs requbed byall conbadom
Value of Construction (labor, materials, profit)
Address
Lz
City/State
--111 will
Zip
Phone
q
Address
City/state
p
Phone
Address
City/State
Zip
Phone
%ilPlun)W
`r�7531
/..r;?-r)j
ID
Are you paying taxes here or by report? 0 Here fit Report
Are you paying with your trust account? JR Yes ❑ No
Is this a residential or�cqmmercial project? ❑ Residential ❑ Commercial
If residential, is it 10 Single Family Detached 0 condo/tbwnhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: O Bank p Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
U Restaurant 0 Other (explain)
Is this building 50 years of age or more? ❑ Yes Q No Ifyes, you mayneedto contactHis[nrlcPreservatfon
If this is for a demolition permit, what year was the building constructed?
Ifprlor to 1975, you will need an asbestos assessment to submit widr llris application.
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or Gly of Ft Collins license #
Electrician Plumber. Mechanical Roofer '" r24 f 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. k
Applicant:
Print Name:_
Date 4t'f' l