HomeMy WebLinkAbout613 Cook Dr - Applications/Reroof - 04/06/2012Apr OF 12 0309p Westers Roofing 9705688448 p.1
City of Ss 5 Planning, Development & Transportation
281 N. College Ave P.O. Box 590
Flirt Collins 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 O Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide mak del and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be ac d_
Applications # �o q Date
For oli% rW only
Sob Site Address (squired)
Value of Constructio�bor, materials, Profit)
Property Owner Name
Address
Cityistate Zip Phone
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pi cant Name
Address
/State zip phone
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Contractor
Address
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U City/State Zip Phone
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Contractor City of Ft. Collins
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Are you paying taxes here or by report? ❑Here EX Report
SalesWxnumbertsrepurre?byall
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Yv�rTti
Are you paying with your trust account?Yes ❑ No
Is this a residential or commercial project? jA Residential ❑ Commercial
IF residential, is it:-C!LSingle Family Detached ❑ Condo/townhome (single family attached) ❑ Dupiex
❑ Multifamily (apartment) ❑ Garage
If commercial, Is It: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ medical ofFlce ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑Yes .73No If yes, you may need to contact HstoricPrL_rvalion
If this is for a demalibiron pernnit, what year was the building constructed?
Ifprior to 1975, you will nerd an asbestos asseasmerrt to submit Aft this applAmiron.
Description of work
*If lawn sprinlderlbaci low preventer, must list licensed plumber. If first-time A/C, must list sed electrician.
Su beontractors: List 0e company name or City of Ft Collins &Lrase #
E12C4ician 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 dty ordinances and state laws regulating building construction. 1 know that a
permit Is not valid unt8 it has been paid and issued.
app6cant;
Print Nam
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Date