HomeMy WebLinkAbout513 Crestmore Pl - Applications/Reroof - 04/05/2012 (2)04/05/2012 14:20 19702241211 ROCKY MTN ROOFERS PAGE 01/01
Fo` �'fty t of,
Planidag, Development &Transportation
281 N. Callege Ave P_O. Boot 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). C7 Air Conditioning
0 Demolition (interior non-structural) ❑ Electrical Alteration (not service change) 11 Gas Lighter ❑ Gas Log
❑'Heating Unit 0 Lawn Sprinkler 0 Mobile Home replacement Aoofing ❑ Sewer Line ❑ Photo -voltaic
0 Ventilation ❑ Water HeAter 11 Water Line ❑ Wood/Pallet Stove (must be EPA certified. provide make, model and
manufacturer).
Complete all applicable information on the application Incomplete applications will not be accepted.
AppliCaUon # 13 Ie)-10 P Date 5 j k,
For of a um only
lob Site Address (egatred) Value of Construction (labor, ma ertals, profit)
�r'3 C�es��a2e P� $ IRa,
Property Owner Name Address
City/state Zip
Phone
t4-Net - Ph I �.fp-"J S"1 3 Cx&5 Vwe A F04-r6ck-r art !
4 g ra7�
Applicant Name Address
Crty/state Zip
phone
Contractor Uc # �. 1`183 Address
city/State Zip
Phone COO
K oC K Yrcu nt&i' r\
C Co
22A -1 z-0D
Conb'actor City of f3. Collins Sates Tax # LA \ 72 lLp
Are you paying taxes here or by report? ❑ Here Jif Report:
saAsrarixdnNr-& logrdradby af c&*adum
Are you pdyhtg with your trust account? $ Yes
❑ No
is this a residential or commercial project? 1AResidendai El CAmmerc[ai
If residentlei, is it: 0-single Family Detached la condo/tdwnhome (single family attached) 0 Duplar
❑ Multifamily (apartment) ❑ Garage
if commercial, is it: O Bank 13 Bar ❑ Oui rh [3 Hotel/Motei ❑ Medical office Q office E3 Retail
❑ Restaurant 13 outer (explain)
Ls this building W yeaM of age or more? C l Yes JKNa lfyEs, ynu may need in odd N1-MW c PreservaGav
If this is for a demo!•rtion permit; what year was the building constructed?
, fprim• m I97S, yt w will need an ash assezmfft to submit MO this app/kabon.
Description of work Z`�A-�2 bootr- of •f- o•'- SIyP� Zoo y¢ ��P Dvc y ( t/,fr rf-
Neuc�Qoo F m �La�` ono>� r�eeo-) tZePL&�,g lam, 6��T7,r�6eaCi ��•�7/�-
4ACA Lee = a D .
*If Lawn spMkier/baddlow preventer, must Gst licensed plumber_ If first-time A/C, must list licensed hum' .
Subconbutors: List the carWnyname or City of Ft Lzltires Pry
t9kXtACldrr Pl1J rAw Medianiral ROOfer A, / Oe*r
I hereby advww,igdge that I hmm read this appliratloh and state that the above inmnyounn is complete and cones. I agree to
c wq* with all requirements contained herein and sty ordinwrces and stye laws regulating building constructiom I know that a
permit is not valid until R has been paid and issued.
AppkaRL-
Print Naats: 9AJSigr►atire Date
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