HomeMy WebLinkAbout2218 Stoney Pine Ct - Applications/Reroof - 09/30/201109/30/2011 13:12 19702241211 POCKY MTN ROOFERS PAGE 01/01
Planning, Development & Transportation
City Gf 281 N. College Ave P.O. Box 580
Flirt Collins 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 pennies only (check all that apply). ❑ Air Conditioning
❑ Demolition (Interior non-structural? ❑ Electrical Alteration (not service change) a Gas Lighter ❑ Gas Log
Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement fi400fing ❑ Sewer Line ❑ Photo -voltaic
C] Ventilation Cl 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 # Dam
For off a we arty
cob Site Address Moquiredj Value of Construction (labor, materials, profit)
2 Z/ SToN �ir�� �° $
Property Owner Name Address
City/State Zip
Phone
a 61n/4 N ZZ/ F- STON /D/tic C,4 Fram �vsAS
Applicant Name Address
CRy/State Zip
Phone
Lic# V-1��Address
ity/State ZIP
Phone q-10
oContractor
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r't7 ClK-, ��l-i(ltZll r> �r� J `,.\. (
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Contractor City of Ft. Collins Sales Tax # y 13'll`p
Are you paying taxes here or by report? ❑ Here
Report
Sale$ & x nwn&erjS requked by aN mrrbaars
Are you paying with your trust account? Jd Yes
❑ No
Is this a residential or commercial project? gResidentlal ❑ Commercial
If residential, Is'iD xa Singte Family Deed ❑ Condo/bDwnhome (single family amached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, Is It: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel 0 Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age of more? ❑ Yes A14o ifyts, you may need to contattHLsYonfc Preservation
If this is for a denmridon permit, what year was the building constructed?
If prior to 1975, you mff need an aoestrrs assessrrrent to submit with ffi/s application.
Description of work
*If lawn sprtnkler/backnow preventer, must fist ficensed plumber. If first-time A/C,'must list licensed electrician.
Subcontractors: List die mmpary name or Cly off? Collins i/cense .4 �/CL%770?G01�1��5
1
eectrician Plumber Mechanical Roofer
Other
I hereby acknowledge that 1 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 know that a
permit is not valid until It has been paid and issued. J
Apprrcatlilt- y F/Zi�(�
Print Name: Signature
Dabe 9
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