HomeMy WebLinkAbout411 Garfield St - Applications/Reroof - 09/12/2011Sep .l2. 2011 6:03AM Bob Behrends Roofing
i No.3143 P. 6
FCiof
ort Cothns
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 use*to apply for the following permits only (check all that apply). ❑ Air Conditioning
❑ Demolition (interior non-strimtural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn SprWer ❑ Mobile Home replacement_ARoofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable infonnat n on the application.
Application #
for office use only
Incomplete applications will not be accepted.
Date
Job Site Address (required) Value of Construction (labor, materials, profit)
Property Owner Name
Address
City/State
Zip
Phone
Applicant Name.
Address
City/State
Zip
Phone
\
Contractor Lic #
Address
City/state
Zip
Phone
t ono
Contractor City of Ft. Collins S&_s Tax #
Are you paying taxes here or by report?Here
❑ Report
sviestax number&requimdbyarcaodors
Are you paying with your
trust account? Yes
❑ No
Q\NXo�y
Is this a residential or commerci� project? �ftesidential ❑ Commercial
If residential; Is it: �inglefamOy Detached ❑ Condo/townhome (single family attached) ❑ Duplex
Cl Multg4m y (apartment) ❑ Garage
If commercial, is it: ❑ Bank UBar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaumt ❑ Other (explain)
Is this building 50 years of ageor more? ❑ Yes�No If yes, you may need to contact Historic Preservation
if this is for a demolition peral t what year was the building constructed?
If prior to 1975, you will need aoasbestos assessment to submit with this applicat/on.
Description
0
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*If lawn sprinkler/backflow prevetler, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or Gty of Ft Collins license 0
Electrician Pluntler Mechanical Roofer Other
I hereby acknowledge that I havemad this application and state that the above information is complete and correct. I agree to
comply with all requirements contaned herein and city ordinances and state laws regulating building construction. I know that a
permit is not valid until it has3een paid and issued..
Applicant: �' \\
*PrintNamSignature e:\�O ca \ _ za Date