HomeMy WebLinkAbout3517 Fieldstone Dr - Applications/Reroof - 07/23/2014Fort Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
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 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 # ` D 3
For ofce use only
Date July 23, 2014
Job Site Address (required)
Value of Construction (labor, materials, profit)
3517 Fieldstone Dr
$2700.00
Property Owner Name
Address City/State Zip Phone
David & April Manifold
same Ft Collins, CO 80525 970-282-4441
Applicant Name
Address City/State Zip Phone
Michael Slaughter
916 38th Ave Ct. #6 Greeley, CO 80634 (970)330-7881
Contractor
Address City/State Zip Phone
Slaughter Roofing CO
916 38th Ave Ct. #6 Greeley, CO 80634 (970)330-7881
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑✓ Here ❑ Report
Sales tax number is required by all contractors
Are you paying with your trust account? v❑ Yes ❑ No
38653
Fort Collins License #R-1703
Is this a residential or commercial project? E] Residential ❑ Commercial
If residential, is it: ❑� Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex o
El (apartment) ❑Garage 001
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 ❑✓ No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work Tear off shingles to the decking. Install base felt paper, drip edge, ice & water shield, adequate ventilation and
dimensional shingles. 27sq
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license #
Electrician Plumber Mechanical Roofer R-2279 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: - -
Print Name: a Signature Date July 23, 2014