HomeMy WebLinkAbout4349 Shadowbrooke Ct - Applications/Reroof - 08/15/201108/16/2011 12:59 FAX 3037575097
NORTH NEST ROOFING
f21003/007
C+olt�ns
Planning, Development & Transportation
283 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) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ,J i Roofing ❑ Sewer Line 0 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 # b� �� �> ,_�j,�� Date
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
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Property Owner Name
Address
City/State Zip
Phone 970
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Applicant Name /�
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Address
City/State Zip
Phone
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Address
City/State Zip
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Phone
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actor City of Ft. Collins sales Tax #
Are you paying taxes here or by report? k Here
❑.Report
sales
tax number is, required by all contractors.
Are you paying with your trust account? ❑ Yes
Ir No
Is th s a residential or commercial project? grResidential ❑ Commercial
If residential, is it: R Single Family Detached ❑ Cando/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 th building 50 years of age or more? O Yes # No If yes, you may need to contact Historic Preservation
If thi is for a demolition permit, what year was the building constructed?
if r to 1975, you will need an asbestos assessment to submit with this application.
Description
of work , S
*If lawn
Sub
Electr
sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
ontractors: I List the company name or City of Ft Collins license # e
cian I Plumber Mechanical Roofer J'/5*�r" 6roUther
r acknowledge that I have read this application and state that the above information is complete and correct. I agree to
with all requirements contained herein and city ordinances and state laws regulating building construction. I know that a
is not valid until it has been paid and issued,
ant: C
Name: /, L"rt JAarI.-, Signature Date