HomeMy WebLinkAbout5117 Ziegler Rd - Applications/Reroof - 11/30/2011NLI
11 02:19p A J Shirk Roofing
19706695999 p.2
10e r- 7"D o u r 14-4- Ice-
8'�L 5 L 6 s'
0 V'e (u tiC'4 Co Planning, Development & Transportation
City of �O S 3 "7 281 N. College Ave P.O. Box 580
��a ��� � Fort Collins, Co 80524
�6�,t
H / tjc S Phone 970-41&2740 Fax-22,"134
� 1 2-' �
_jE-COUNTER PERMITS ONLY
OVER T
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 se ce change) ❑ Gas Lighter ❑ Gas Log
Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement Roofing t7 Sewer Line ❑ Photo-keftaic and
❑ Hea g provide make, ❑ Ventilation ❑ Water Heater O Water Line ❑ WoodlPellet Stove (must be EPA certified, p
manufacturer)•
complete all applicable information on the application. Incomplete applications will not be accepted.
c
Application # b I I 10 0 S Date -
For office use only
lob Site Address (regLffred) --TIZValue of Con on (I bor, materials, profit)
ki ;�
p er Name Tess Gty/Sta Zip Phone
r,
Address City/State Zip Phone
Applicant Name
---S 5j6 i r k o? 00-FI
Contractor Address l �Yls � Phone
1 Zip V'o
�. .r LSO t'I r, Say E. Ve jaw O j Sc>s3% 6 & - 99 9
Contractor City of Ft C011ins Sales Tax # Are you paying taxes here or by report? ❑Here .9 Report
Sales taxn�emberis�groredb)'a/Icvrtra�ovS y1 0 3 Are you paying with your bust account?,gYes ❑ No
Is this a residential or comrner ial project? residential ❑ Commercial
If residential, is it ❑ Single Family Detached ❑ Condo/townhome (single family attached) ' ❑ Duplex
❑ Multifamily (apartment) ❑ Garage M Zar'n
If commercial, is it ❑ Bank ❑ Bar ❑ Church ❑ Hob*Motd ❑ Medral office ❑ Office ❑ Retail
❑ Restaurant 0 Other (explain)
is this building 5o years of age or more? ClYes ONO If yes, you may need to rnntact H&Vnc Presenratlon
If this is for a demofWn permit, what Year was the building constructed?
if pn"or to 1975, you will need an asbestxts asR5wnent to submit W fi this applaation. k—dL
Description I work
*If Lawn sQd Ider/baddtow pmverCer, must list licensed plumber. If first time AJC, must list licensed etectridan.
Subcontractors: list the c rnpianyname or LnyofFtCa&nsIfiamse # R 155-9
ElecMaan plumber Medtani al Roof , Other
I hereby admawledge 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 consbu Lion. I know that a
permit is not valid until it has been paid and issued. f
Applicant:
Print Nam
'10 11 02:19p A J Shirk Roofing 19706695999 p.1
f'a5� 0-1 10erM 14- % Ou �'-ICE
ga s L ,
z v,e lu vid planning, Development &Transportation
city of *O 537 281 N. College Ave P.O. Box 580
Flirt Cottins 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
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not keer)Ace change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement A Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation 0 Water Heater 0 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.
A lication # Date �� �� 6 l%
PP Fwolr use only
F_
Job ate,Address (required)
- value of Co
-on (labor, materials, pro
_F`n /—
?) Nm
2�0?
a&
Property owner Name
Address
CityJState
Zip Phone
_ 723
Applicant Name
Address
City/State
Zip Phone
V7
Contractor
Address
WState
Zip Phone
-I S is v o �c,7
�d5 E. loST ve jar, of
o 8o5 37 6 & - 99
Contractor City of Ft. Collins Sales Tax
#
y 3
Are you paying taxes here or by report? ❑ Here .f Report
Sales tax number is required by afl contracwm
Are you paying with your
trust account? X Yes ❑ No
Is this a residential or conjmerdal project? A Residential ❑ Commercial
If residential, is it: Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑liar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? O Yes �No If yes, you may need to contact Historic Preservabbn
If this is for a demolition permit, what year was the building constructed?
Ifpn'or to 1975, you will need an asbestos assezment to submit witfi this application.
on of work
*If lawn sprinkler/backfiow prevent6r, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of ft Collin license 0 R 15 0
Dean Plumber.
Medianical 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'( ) -ghalm
Print Name-�� '