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Home My WebLink About6603 Antigua Dr - Applications/Reroof - 02/29/2012 (2)02/28/2012 19:46 9703539774 Forrt of INDEPEDENT ROOFING I PAGE 02 •J Planning, Development &Transportation 281 N. College Ave P.O. Box 580 Fort Collins, CO 80524 l� Phone 970-416-2740 Fax 224-6U4 J 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 X Roofing ❑ Sewer Line ❑ Photo -voltaic ❑ Ventilation ❑ 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. Application 9 LI14 Date , rar olio cse only. ]ob Site Address ulred) 3 Value of Construction (labor, materials, orofrt) $ .(o(v3 5 3sd�s, Property Owner Name fror; 0.G-t. .Address City/State Zip y'O Phone /'�llail'e h'15! �t%(�inS `611SaS t01 Applicant Name=770-LL3• q�pff Address City/Stag Zip •. +aOQ Phone Same ' Contractor Lfc #R2 9 4 Address Gty/State Zip Phone Independent Roofing Inc. 405. 22nd St., Greeley, CO 80631 970-353-1389 Contractor Gty of FL Collins Sales Tax # Are you paying taxes here or by report? ❑ Here )I Report SawstarrnwnDffsrnawwbywcanoarlom Are you paying with your trust account? Z] yes ❑ No Is this a residential or.commerdal project7 ® Res,�id,� al ❑ Commercial Vn�idential, Is It ❑ Single Family Det xhed ado/townhome (single family attached) ❑ Duplex ❑ MutMmfly (apartment) ❑ Garage If commercial, is It ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office Cl Office ❑ Retail ❑ Restaurant ❑ Other (explain) Is this building 50 years of age or more? O Yes CYNo I!`yes; yrw moray need to m—ata HiHis7aric Preserraml w ff this Is for a demoltt9on permit. what year was the building constructed? D`priar to 1975, ynu w111 need an asM=sazemnentto submit w/tb thls appht:70n *1 lawn spir0 r/baddlow preventer, most fist licensed plumber. If first-time A/C, must I"rst licensed elec bidan. Sobconitac6srm Ltst'the company name or aty orR ClIft &mrzse f plumber Me&Qrzicm gwl6 d'-1 `t DOW -eraoy actatowteage coat I have read this application aW State that the above information is complete and Corr= I agree to APM with ell requirements contained herein and dry ordinances and state laws regulating building constriction. I know that a perotit is not valid unbl 'it has been paid aid ice. Applicant PontName: . r t tr► rc vi,etr Signature /� Dates 02/28/2012 19:46 9703539774 INDEPEDENT ROOFING I PAGE 03 'City,Of i Planning, Development &Transportation ForColons Forst Collins, Co College 90524 O. Box 580 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 0 Demolition (interior non-structural) 0 Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log 0 Heating Unit ❑ Lawn Sprinkler O Mobile Home replacement X Roofing ❑ Sewer Line D Photo -voltaic 0 Ventilation ❑ Water Heater 0 Water Line 0 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 # Ia00�i `-IS Date 42_ �a For of en its,- only Job Site Address L(0o3 _.1 Property Owner Name ('� r, ?c�+ G• t' . Address / /,tort e tY) 5 Applicant Name Address Same Value of Construcsion (labor, materials, orofitl City/State jt.C(/ins C City/State Zip 0/0 Phone Zip Phone r Contractor Lic #R294 Address City/Stage Zp Phone -Independent: Roofing Inc. 405 22nd St., Greeley, CO 80631 970-353-1389 Contractor City of PL Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ?0 Report -%iWt2rnrmbVIS''rW0Wbrallcontractors. Are you paying with your trust account? M Yes ❑ No Is this a residential or.eomrnercial project? GResidpMial ❑ Commercial If residential, is It ❑ Single Family Detadted do/townhome (single family attached) ❑ Duplex O Mutttfamlly (apartment) ❑(gage If commercial, is tG E3 Back ❑ Bar ❑ Church ❑ Hatel/Motel ❑ Medical office ❑ Office ❑ Retail Cl Restaurant ❑ otfier (e)qplaln Is this building 30 years of age or more? O Yes MNo Yyes; you twy new to cvnggct Hlst c preseivaDF If this is for a demolition permtk what year was the building constructed? Ifpnor m IS75, ym wfff need an asbe=s arse gVJ&rt m svbmlt wftlr this appjr blon. Description of work *If lawn sprinkler/backflow preventer, must rrst licensed plumber. If frnqt-time A/c, must fist licensed electrician. Subcontractors L& date company name or L7ly or Ft C�Wrs fog ar Betbidan . Plumber mw rdrall Roofer , other remby admowledge that I have read this application and state that the above infOrrilZbOn is complete and correct I agree to ..nply 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 1 Print Name: t Y1 . Signature Date a i Q — .'1 _