HomeMy WebLinkAbout200 W Foothills Pkwy - Applications/Reroof - 09/29/2011City of
F6rt Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
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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 ® 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 applications will not be accepted.
Application #
For office use only
Date September 29, 2011
Job Site Address (required)
Value of Construction (labor, materials, profit)
200 W Foothills Parkway
$24,300 (243 squares)
Property Owner Name Address
City/State Zip
Phone
Wild Oats Market, Inc. 1821 30th St
Boulder CO 80401
303.862.1709
Applicant Name Address
City/State Zip
Phone
Tecta America Colorado LLC 1881 W 13th Ave
Denver CO 80204
303.573.5953
Contractor Address
City/State Zip
Phone
Same
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
El Here ❑ Report
5aiestax number isrequired byall contractors.
Are you paying with your trust account?
❑ Yes ® No
44284
Is this a residential or commercial project? ❑ 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 x❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes 0 No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If pr1or to 1975, you will need an asbestos assessment to submit with this application.
Description of work Tear off, add 3" of Polyi
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1/4" Dens Deck and 48 mil PVC roofs
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*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
_WIX
Mechanical Roofer R-2154 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 know that a
permit is not valid until it has been paid and issued.
Applicant:
Print Name: Lisa Medio Signature Date 7