HomeMy WebLinkAbout309 Tiflin Ct - Applications/Reroof - 09/24/2011Sep 23 1.1 02:02p 5 Star Roofing Co.,LLC
970-663-7827 p.2
FCiof
®rt 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 711loofing
ice change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stoe(must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application #' I (d Date q10? q Z
Far of a use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
tour 1 ii n Cf
a
Property Owner Name Address
City/State Zip
Phone
Sco Durcu-) b0cff Ti i
E+111tmosj Co 252e)
grlo-_�)-ao-2-1Ia'
Applicant Name Address
City/State Zip
Phone
Star r_4115 NU--C P_ x w W 'St
Lbv el CLi�L, G0 & F r7
LDb?- -C- l 1 C
Contractor Address
City/State Zip
Phone
r "�trr 11, L1� 12- 1 ire `NJ� "
St Lev l co-t l CO
Contractor C f Ft. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here gReport
salmi fax number is repuined byaffconbacrom
Are you paying with your trust account? �g Yes ❑ No
Is this a residential o mercial project? .Residential ❑ Commercial
If residential, is it: A Single Family Detached Cj Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) P..Garage
If commercial, is it ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No If yes, you mayneed to contact Historic PreseWbon
If this is for a demolition permit, what year was the building constructed?
Zf prior to 1975, you wi/I need an asbestos assessment to submit with this applilcatron.
Of
*If lawn sprinklerlbadQlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or Gty of R Col/ins license #
Electrician Plumber Mechanical Roofer 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 statellaws regulating building construction. I know, that a
n
permit is not valid until it has been paid and issued. 1 \ 4
Applicant: /
Print Name: �i i- c%�! LzIl1� Signature
Date dab