HomeMy WebLinkAbout536 Charrington Ct - Applications/Reroof - 09/19/201109/19/2011 11:58 9703305645 SLAUGHTER ROOFING PAGE 03/07
City of,,,
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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) O Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing C3 Sewer Line ❑ Photo -voltaic
❑ 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 # bI102- Date &vr
for oliro° use only
Sob Site Address (required)
Value of Construction (labor, materials, profit)
- ltJ TO IJ CT
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Property Owner Name Address
Zip Phone
rCity/State CO
V frc.. CO O
Applicant Name Address
City/State Zip Phone
MIGHNEL, 2UMAVEFE 2J10
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Contractor Address
City/State Zip Phone
217,0C A005E
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? )q Here ❑ Report
sal s
Are you paying with your trust account? Pill Yes ❑ No
Are
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Is this a residential or commercial project? 10 Residential ❑ Commercial
If residential, is it: IX Single Family Detached ❑ Condo/townhomc (single family attached) ❑ Duplex
O Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel O Medical office ❑ Office ❑ Retail-
C7 Restaurant ❑ Other (explain)
Is this bullding 50 years of age or more? ❑ Yes )ONO If yes, you may need to contact Historic Pfesemation
If this is for a demolition permit, what year was the building constructed?
Ifpnor to 1975, you wiz/ need an asbestos assessment to subm/t with this application,
Description of work
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*If lawn sprinkler/baddlow preventer,, must list licensed plumber. If first-time A/C, must list licensed electrician.
subcontractors: ust the company name or City of Ft Collins license #
Seariaan 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:
Print Name: Signature
Date 11