HomeMy WebLinkAbout1156 Belleview Dr - Applications/Reroof - 02/05/201402/05/2014 09:41 9705930124 GOLD ROOFING INC PAGE 02/04
of
Fort 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 on check all that apply). ❑ Air Conditioning
❑ Demolition (interior non-s4ructural) ❑ Electrical Alteration (not serve change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ 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 information on the application. Incomplete applications will not be accepted.
Application # U1 " 0 n S 1 B
For offlce use only
Date 2- S/�
Sob Site Address (requlrad)
Value of Constru$ion (labor, materials, profit)
!r lle v,rew�
�lll �{� o • �"
PropertyQawfle"hame�
City/State Zip Phone
�16e�Address
41
Applicant Name Address
City/state Zip Phone
(1*003130490
Contractor ,,��}}- Address City/state Zip Phone
6- / f 13 � y Ids' e . koye&u7d 46 9—3 7
Contractor City of Ft Colll Sales Tax #
Are you paying taxes here or by report? ❑ Here PAeport
sales tax number/sregairedbya0mntraQors
Are you paying with your trust account? P Yes ❑ No
Is this a residential or commercial project? ❑ Residential ❑ Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) wDuplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ 9ank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? O Yes PNo If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
rfprior to 1975, you will need an asbestos assessment to submit wlth th/s application.
*If lawn sprinkler/backgow prevent9r, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Gbllins Ikense 0
Elect(clan 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 (mow that a
permit is not valid until it has been paid and issued.
Applicant -
Print y /
Print Name: Bower- Signature Date �