HomeMy WebLinkAbout3630 Arctic Fox Dr - Applications/Reroof - 10/18/201110/18/2011 14:46 9703305645
City of _
SLAUGHTER ROOFING
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Ph4n% 97V-%H740 FRIG m-fini
OVER-THE-COUNTER PERMITS ONLY
PAGE 04/07
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 O. Gas Log
❑ Heating Unit ❑ Lawn Sprinkler 11 Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater O Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable i(n�foo�rmatiopn� on the application. Incomplete applications will not be accepted.
Application # 61 � 7 8 Date
roroAix- use only
Job Site Address (requlred)
Value of Construction (labor, materials, profit)
3 A T►.
2 2 0 0
Property Owner Name Address
city/State 2p Phone
v A A L
G S Z
Applicant Name Address
City/State Zip Phone
MivvaL 7A
Contractor Address
City/State Zip Phone
ZI?A CW
ow 0
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? JR Here O Report
Sale��syyQ3rnumber Isrequbedbyal/cm*vd=
Are you paying with your bust account? $ Yes ❑ No
Is this a residential or commercial project? 0 Residential ❑ Commercial
If residential, is t: V Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) Cl 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 jiJ No .lf yes, you may need to Contact HlstoricPreservadon
If this is for a demolition permit, what year was the building Constructed?
Ifprlorto 1975, you wi// need an asbestos assessment to submit w10 [his application.
Description of work
O -: i I'
--Ir lawn spnnider/backRow preventer,:must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors. list bhe company name orC/ry of1TCollins/icense #
RecMdan 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" A J —
Print Name: 1,/&�JSLAu(,NTE1Z Signature pate