HomeMy WebLinkAbout4137 Tanager St - Applications/Reroof - 07/15/2014-71).3
City of
� F6r_t 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 C] 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 # 8 t q () �3 I Date 7�1 -51 q
For ofce use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
4137 Tanager Street Fort Collins CO 80526
$3420.00
Property Owner Name Address
City/State Zip
Phone
Sara DeRouchey 4137 Tanager Street
Fort Collins, CO 80526
9702184475
Applicant Name Address
City/State Zip
Phone
Zack Stanevich 2614 S. Timberline Rd. #109-182 Fort Collins, CO 80525
9702905393
Contractor Address
City/State Zip
Phone
Select Roofing Contractors, LLC 2614 S. Timberline Rd. #109-182 Fort Collins CO 80526
9702905393
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? ❑ Yes
@ No
Is this a residential or commercial project? Q Residential ❑ Commercial
If residential, is it: ® Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
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 M No Ifyes, you mayneed 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
*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
Mechanical Roofer R-2414+ 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.
Applic nt:
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