HomeMy WebLinkAbout1501 Centennial Rd - Applications/Reroof - 11/07/2011Nov 07 11 01:51 p FM Roofing Inc.
1-970-221-8526 p.1
CI f Planning, Development & Transportation
tY O281 N. College Ave P.O. Box 580
Flirt Collins Fort Collins, CO 80524
`- Phone 970-416-2740 Fax 224-6134
OVER-IME-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-structur.ifi ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Horne replacement 11Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ )'Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable inlformat cm on the application. Incomplete applications will not be accepted.
Application # 11 1 0 l 1 E Date
For office usie only
Job Site Address (required) Value of Construction (labor, materials, profit)
S ol k $
Property Owner Name -
Address
City/State Zip
Phone
0-A4&y1tr-k-\
64A-Y _ k E
S30 - 350/
Applicant Name -
Address
City/State Zip
Phone
Contractor Lic #
Address
City/State Zip
Phone
R1 Roofing Inc. R-400
1629 S_
Lemay Avenue Ft. Collins, CO 80525 970-221-1388
Contractor City of FL Collins Sates ' "ax #
Are you paying taxes here or by report?
IN Here 0 Report
-ate tax number is required by aff mn&aa zs
185 96
Are you paying with your trust account?
❑ Yes [B No
Is this a residential or commercial pn>ject? $WResidential ❑ Commercial
If residential, is it: i&Single Famill Detached 0 Condo/townhome (single family attached)
❑ Multifamily ( apartment) I:1 Garage
If commercial, Is it; ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office
■=
❑ Retail
❑ Restaurant ❑ Other (ecpWn)
Is this building 50 years of age or inore? ❑ Yes ❑ No ifyes, you may need to conbaHisWricPreservauon
If this is for a demolition permit, vilaat year was the building constructed?
ifpnur to 1975, you wr7/ need an as( Y:sazs assessment to submit wia5 this appAcobbon.
*If lawn slainider/backflow preventer, recast list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company ni me or Gly off I, Collins license #
Electrician Plumber__. _ 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 containec herein and city ordinances and state laws regulating building construction. I know that a
permit is not valid until it has bees i paid and issa,ied.
Applicant:
Print Name: Signature Date