HomeMy WebLinkAbout7421 Stonington Ct - Applications/Reroof - 10/14/201110/14/2011 10:44 9702212411 PDR OF N COLORADO PAGE 02/02
Planning, Development & Transportation
City of 281 N. College Ave P.O. Box 580
FOI�� COLLinS Fort Collins,
CO 80524
Phone 970-41616-27402740 Fax 2246134
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 J9 Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater D 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 #
For oiirce use only
Date /0LALZo11
Job Site Address (required) Value of Construction (labor, materials, profit)
-)42► S-fnnin h Ct � 3,BDo
Property owner Narhe,' Address City/State Zip Phone
L-e5l i e- Yow/'t.- 14915 +nin'fon �ir�Colllhs, Co 8o5z5 (a-ro 37"1-1572
Name Address
tiy i S R04ora+ion 309 Lima In Ct
City/State
ollins. CD
Zip
8o 524 6
Phone
221- 1281
Contractor Lic # Address City/State Zip Phone
Paul J7avig ,349.6inCa/H Ct trrfCnl/ins, Co 8aS24 j4'16)Z21-12ei
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ❑Report
Sales tax number is required by ell contractors. Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? N Residential ❑ Commercial
If residential, is it: 19 Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ 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 9 No ..If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
if prior to,1975, you will need an asbestos assessment to submit wi7h this application.
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Ust the companyname or City offt Collins license #
Electrldan_ — 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 constructlon. I know that a
permit is not valid until it has been paid and issued.._'e�
Applicant: G f
Print Name:_ r��