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HomeMy WebLinkAbout2819 Fieldstone Dr - Applications/Reroof - 07/21/201407/21/2014 07:51 9705930124 GOLD ROOFING INC PAGE 01/01 Planning, Developmettt & TrarrspoftDon 281 N. College Ave P.O. Box 580 Fort Collins, CO 8Q524 Phone 970-416 2740 Fax 224-6134 OVER-THE-COUNTER PERMITS ONLY This applioabion is to be used to apply for the follovdrig permits only (check all that apply). L7 Air Conditioning M Demolition (interior non-structural) • 0 Electrical Alteration (not service change) 0 Gas Lighter 0 Gas Log ❑ Heating Unit ❑ Lawn Sprinkler 0 Mobile Home replacement 13 Roofing Q Sewer Line . 0 Photo -voltaic E3 Ventilation 0 Water Heater 11 Water Line ❑ Wood/Pellet Stove (must be EPA cerhiled, provide make, model and manufacturer). Complete all applicable Information on the application. Incomplete applications will not be accepted. Application C) y l U-1 .1t For offm uw only lob Site Address (mgaw) Value of Consbuction• (tabor, materials, profit) 2 gi 9 ��e 6ds��►e 4r. $ Property Owner Name Address City/State Tip Phone �ah +' Cartd San e Applicant Name Address CRY/State Tip Phone (,WC4 s' • go-me's Contactor Lic # R''357 Address •12q City/State Tip Phone aid 9001ffivl il;% `K/m [ 0 053 1762L- Contractor City of Ft Collins Sales Tax # Are you paying taxes here or by report? ❑ Here 17 Report rrxnr►mba�ks,e�rbedbyalJcnrlrrauwz Are you paying with your trust account? p Yes © No Is this a residential or c9mmerdal project? 10 Residential 13 Commend If residential, Is It 9 Single Famtiy Detached C3 Condo/townhome (single family attached) 13 DupteX C3 Multifamily (apartment) Ca Garage If commercial, Is it C3 Bank E3 Bar 13 Church 13 Kotel/Motal 13 Medical office E3 office M Retail 13 Restaurant 0 outer (explain) is this building 50 years Wage or more? Q Yes U No If yes, }rou may need to mnwer ffistowe Presenahl7n if this is for a demol ion permit, what year was the buitding constructed? Yprfm m 194 yeru will need an asbefts assessamt to wbmt wrilr this application. Work *If lawn spriNWer/backilow preAv tax, must fist licensed plumber. If first-time A/C, must list licensed electrician. Sal =ntractws: Lis tdr2comp arrynarneor0yofRColRns/bmw Eiedridan Nurrher, Roofer Other I hereby admowiedge that I have read this appffcaffa - and state that the above kdbunotim is Complete and correct I agree to comply with all requirements contained herein and dty, ordlr wx= aril state laws regulating building construct on. I know that a pern it is mA vaifd railil it has been paiii and issued. ' APr e � ,� /11 j Pont Alame: dtrn S ` � .