HomeMy WebLinkAbout5220 Boardwalk Dr - Applications/Reroof - 04/02/2012 (12)04/02/2012 10:29 9705930124 GOLD ROOFING INC PAGE 16/24
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Cityof
Flirt COLlins
Planning, D wtalopment & Transportation
281 N. College P1ve P.O. Box 580
Fort Collins, CO; 80524
Phone 970416-:2740 Fax 224-6134
OWR-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). 0 Air Conditioning
0 Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter 0 Gas Log
0 Heating Unit 0 Lawn Sprinkler ❑ Mobile Home replacement Roofing 0 Sewer.Une 0 Photo -voltaic
❑ Ventilation 0 Water Heater 0 Water Line I3 Wood/Pellet Stove (must be EP'A certified, provide make, model and
manufacturer).
Complete all applicable information on the appfication. lmmmplete applicatiions will not be accepted.
Applicafion#jl�C��3� Date:��t?a•��
Forotiim we only
lob Sift Address lwuwI
59,2.0 bo ral14 bk. Pre go
Owner Name LIA)Oncr� ) Address
oewA %rviNs 1 TAl • eAA
Name Address
.14 .3aue-
Contractor 11 IIC # Address
Mold / J.657 lg2y
Contractor City of Ft Cbhns Sales Tax #
Safe tzrmra��b ! byal7cvne3*rx
Value of Consttruction (labor, materials, profit)
$ j/ g17J"11k,0 _
City/State Zip Phone
�M F , do 9052q
City/State Tip Phone
City/Stage Tip M7,O)Phone
{�rU.Lr C Vda& g65 593 34ffO
Are you paying taxes he re or by report? # Here ❑ Report:
Are you paying with youir truk account? J'Yes 0 No
Is this a residential or Commercial project? ❑ Residential .11a"Cnmmerdal
If rsidentiat, L5 it ❑ Single Fan* Detached ❑ t.athdo(townhome (singie famib,/ attadied) ❑ Duplex
a Multifamily (apartment) ❑ Garage
If oommerdai, is it: CI Bank Cl Bar 13 ; hLm:h 0 I kWl/I�(cel Q Medical office office ❑ Retail
❑ Restaurant other (Mlaln) L' Di7/�61)1 in f IiM M _? Ile.
Is this building so years of age or more? 0 Yes *140 1T)4ES, y+w nay need to w�ct Pr%ervabbn
If this is for a demo fluor permit, what year was the building OMstrud ed?
Drp/w,r to 1975 you M7 deed an asbeses assasrnMtto sub/ntt mvith this apphUdtion
I=_...� !j . •
*if tawn sprinkler/baddtow preventer, must list licerused plumber. If first-time A/C, must Mist licensed elecMdan.
Subcont actoM W the mmparryname orGYyofft CoMW rzw e
�e -135 other
I hereby admowledge tthatI have read this appfxalion and state that the above uhformatim n is compiete and conem I agree to
cornply with all requirements contained herein and city on*mnces acid state laws reg►datin!g building embudimL hi know that a
permit is trot valid unto it has been paid arrd asued. '