HomeMy WebLinkAbout7220 Randolph Ct - Applications/Reroof - 10/28/2011Oct 28 11 01:37p Gold Roofing, Inc.
9705930124 p.5
City0f Planning, Development & Transportation
Fort Collins Fort N. college Ave P.O. Box 580
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) O Gas lighter ❑ Gas Log
❑ Heating Unit 0 Lawn Sprinkler 0 Mobile Home replacement CK 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.
Application # 151 / 0, 1-I
For oflrce use only
Incomplete applications will not be accepted.
Date / 0% S
Job Site Address (required) Value of Construction (labor, materials, profit)
722o /tavtde i P t-, C-f. 1 $ 35. 3 s ar t4ar-c .S
Property Owner Name Address
City/State
Zip
Phone
� 1; z a b o 4 L-% /" I c Ga i`r% 7Z2 c k.
Cf. Fork l
Fo
-2.3 l
Applicant Name Address
City/State
Zip
Phone
C i rr s a N-2`i r: r
tr8 IL;,4. ` e-kv�y,-1
S -37
-!�1 I--3c8C
Contractor Uc # Address
City/State
Zip
Phone
I-S5 7
Contractor City of Ft Collins Sales Tax #
Are you paying taxes here or by report?
►4 Here ❑ Report
.Saies,%DrmmtrerkFrepuvedbyadiamnadns
Are you paying with your trust account?
CkYes ❑ No
Is this a residential or commercial project? 13 Residential ❑ Commercial
If residential, is it: M Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex'
❑ Multifamily (apartment) ❑ Garage
If commercial, is r ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? O Yes 0 No Ifyes, you mayneed tv contact Htslaric Preservation
If this is for a demolition permit, what year was the building constructed?
Ypnor to 1975, you will need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/bacldlow preventer, must fist licensed plumber. If first-time A/C, mint list licensed electrician.
subcontractors use die company name or Gty of Ft Collins license #
Electrician Plumtmr.
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 know that a
permit is not valid until it has been paid and issued.
Applicant: I // •t4�r Signature lG� Date��'4 !w
Print Name: /i 8..� � R