HomeMy WebLinkAbout729 Oxford Ln - Applications/Reroof - 04/18/2012Apr 18 12 04:45p 5 Star Roofing Co.,LLC
970-663-7827 PA
Planning, Development & Transportation
281 N. College Ave P.O. Sox 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-61M
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 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.
Application #.
For oflkz' use only
Incomplete applic boons will not be accepted.
Date q [ )
lob Site AddM
Value of Construction (tabor, materials, profit)
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Property Owner Name Address
City/State Zip
Phone
Applicant Name Address
City/State Zip
Phone
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Contractor Address
City/State Zip
Phone
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Contractor 044 R. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here (Report
SakStaxrrumberasrequved bya#awwadom
Are you paying with your trust account? �R Yes ❑ No
Is this a residential or commercial project? * Residential O Commercial
If residential, is it: IkSingle 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 ❑ No Ifyes, you may need to amtact H6twk Prese wtion
If this is for a demolition permit, what year was the building constructed?
ffpnor to 1975, you will need an asbestos assessment to submit mih bhts appficabfon.
of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: listthe conWnynanre orCrtyofFtCollins /kense d`
Electrician Plumber Mechanical Roofer i2- iG r , 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 stat laws regulating building construction. I know that a
per
mit is not valid until it has been paid and issued. n I
Applicant I Al- C�\( Print Name;till Signature
Date