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HomeMy WebLinkAbout551 Shadbury Ct - Applications/Reroof - 04/23/201204/23/2012 08:23 9705930124 of FoCity. Collins GOLD ROOFING INC PAGE 01/01 Planning, Delvelopment & Transportation 281 N. College AVe P.O. Box 580 Fort Collins, a) 8OS24 Phone 970-416-2740 Fax 229-6134 OVER-THE-COUNTER PERMITS ONLY This application is to be used to apply for the following permlts only (cheek all that apply). 0 Air Conditioning 0 Demolition (interior non-structural) ❑ Electrical Alteration (not service changie) ❑ Gas Lighter ❑ Gas Log El Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ICI Sewer.Line . ❑ Photo -voltaic. ❑ Ventilation ❑ Water Heater 0 Water Line © WoodlPellet Stove (must be E:PA certified, provide make, model and manufacturer). Complete all applicable information on the application- Incomplete applic moons will not be accepted. Application # e I a0 C1 1 &D 'Date 64 - a- - 2ei 19, Far office ise only Job Site Address (requlred) Value of Con,strucition (labor, materials, profit) Property Owner Name Address City/State 23p Phone F Cod/,us Ica 8o3�s �yo_yla-$/i Applicant Name Address City/State Zip Phone f � /.�j7p?4/��1snh0:.[.'.2T'QJcd loyelauc(Co 963.37 4ic-s9Y-3aS Contracbor Lic # City/State zip Phone rAddress Contractor City oFA Collins Sales Tax # Are you paying taxes here or by report? X Here . ❑ Report salestrxnumberKreqcuedbya//contracars Are you paying with your trust account? JM Yes ❑ No is this a residential or commercial project? 0 Residential G] commercial if residential, is it: Q single Family Detactred ❑ Condo/townhome (single fam,lly attached) ❑ Duplez 0 Multifamily (apartment) ❑ Garage If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hobal/Mobel ❑ Medical oft e ❑ office C) Retail ❑ Restaurant ❑ other (explain) Is this building so years of age or more? ❑ Yes IRNo If yes, yrou may need j to cweatt Historic Presetwfian If this is fior a demolition permit, what year was the building consbvcted? Ifpr/or to 1975, you will need an asbestos "^&=wt to subm t wits► iris app/fcaGan. Description of work /a k o CZ, u r /e s *If lawn spanider/baddiow pfeventer, must list licensed plumber. If first-time A/C, music list licensed electrician. subcontractors, List ibe tompanyname or of Ft Lbl ffis hb nse # N Oectr r Plumber � Pcmr other I hereby acknowledge that I have read this applicatign and stye that the above iriform bion is complete and mnecG I agree to comply with all requirements contained herein and city ordinances and slate laws regulatrmg building mnstruCGon. I know that a permit is not valid until it has been paid ailed issued. Applcant: pate 5//� 3 Print Name: Signature