HomeMy WebLinkAbout504 Spring Canyon Ct - Applications/Reroof - 08/25/201108/25/2011 16:41 FAX 3037575097
NORTH NEST ROOFING 0 003/005
,cityof
has
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
O Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement J, Roofing ❑ 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 application will not be accepted.
Application # ll os li% (0��3 Date Z�
For office use only
Job Site Address (required)
Value of Construction (labor, materlals, profit)
Sa nt Gr,no
Property Owner Name Address
City/State If Zip
Phone
4P,e
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Applicant Name n//ff Address
City/State Zip
Phone
�r`f% 40064 �16 fl;ot
Contractor Address
City/State Zip
Phone
kl&F-41N 6)0,5 S.l4'r�� S+ t#zvu vfr CU �/LZL Sow- -0
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Contractor City of Ft. Collins 5ales Tax #
Are you paying taxes here or by report? ArHere
❑ Report
Sales Wnumberifrequired bya//contractors.
Are you paying with your trust account? ❑ Yes
. No
Is this a residential or commercial project? .01 Residential ❑ Commercial
If residential, is it: 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? O Yes ,jZ 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 with this application.
Description of work ✓ ?•
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license #
Electrician Plumber Mechanical Roofer 3 GTRAe then ,
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 clty 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: �r�'tf i t1 Signature Date