HomeMy WebLinkAbout4337 Arcada Ct - Applications/Reroof - 01/12/2012Jan 12 12 10:48a Westers.Roofing 9705688448 p.1
City of Planning, Development & Transportation .
281 N. College Ave P.O. Box 580
6rt Collins Fort Collins, CO80524
`�- Phone 970-416-2740 Fax 224-61M
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) ❑ 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 # -6V 10 Q
For office use only
Date 1 - 12 — / rL-
Job Site Address (required)
Value of Construction (labor, materials, profit)
Property Owner Name
Address
City/State Zip
}lPhone
A plicant Name
Address
/State Zip Phone
a
C
a ,.. .� S LS 1770 (019445
Contractor,
Address
City/State Zip Phone
_
Contractor City of Ft. Collins
#
Are you paying taxes here or try report? ❑ Here Q Report
.Safesbxnumberisregfdredbyallee%,T,4
vo tract,'7 -
Are you paying with your trust account? Yes ❑ No
Is this a residential or commercial project? Jd Residential ❑ Commercial
if residential, is it: ALSingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office . ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ,1KI-No If yes, you may need to contact Historic Preservat/on
If this is for a demolition permit, what year was the building constructed?
If prlor to 1975, you wit/ need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time AJC, must list"nsed electrician.
Subcontractors: List the company name or Gty of Ft Collins license #
Sectridan 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 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.
Applicatlt:
Print Name: Signature
Date