HomeMy WebLinkAbout4366 Starflower Dr - Applications/Reroof - 07/24/2014JUL-21-2014 07:42 FROM:CEDRR CREST ROOFING 970 669 6152 TO:2246134
P.1/3
Fort Collins
Planning, lk"opnmd & Tlrasportatkm
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 geed to apply for the following perks only (check all that apply). 0 Air Conditioning
0 Demolition (interior non-shrrctuml) 0 Electrical Alteration (not service change) 0 Gas Ughter C] Gas Log
0 Heating Unit 0 Lawn Sprinkler 0 Mobile Home replacement ■ Roofing 0 Sewer Una 0 Photo -voltaic
0 Ventlladon 0 Water Heater 0 Water Una 0 Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable kftnwtatlo the awiloation. Mcompbta appiicatione will not be erns
Ap lcatJon # � ; � � Date _ .'
Far oAkb cafe my
Job Sllta AddreQa (regwvd) Value of Construction (labor, materials, prom)
.M I
r
Property Owner Name Address
City/slate Zip Phone
p
Applicant Name Address
Gty/stalae Zip Phone
1,0,JiA I r -U,2 .S
LQU6&dP4 Q> SoiJ-2
Contractor UC # Address
City/state 73p Phone
(fL°DAra gi6s i,
R•i
or
Contredw City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ® Here ❑ Report
Sates Aw nrenber a nakr ~by aN CONVO DIM
Are you paying with your trust amount? ® Yes ❑ No
is this a residential or commercial pro]ed? ® Residential 0 Commerdal
If. residential, Is it: 0 Single Family Detached 0 Condo/bownhome (single family attached) ❑ Duplex
0 MultlramliV (apartment) O Garage
If commercial, Is rc 0 Bank 0 Bar O Church C] Hotel/Motal 0 Medical office O Office O Retall
0 Restaurant 0 Other (explain)
Is this building 50 years of age or more? O Yes ®No Ofyar,. )w mayneed to mnhW N&&* ifbn
If this is for a demolition Pail ndwhat year was the building constructed?
JYPA r to J975, ytw w1/l need an asfi ca a %VnWf 0 sa~ wah 6W 8AW4 UOA
Description of work
*If lave sprinkter/backfiow prevemv, must list licensed plumber. If fint- ime A/C, must list licensed dectHdan.
9uhocnbradors: Lbt Una C4MPaay nNW ar GRy of R Caft &OW 0
L°,P�ss'rso
Phnnber Mad r*ml _ Roorer 1Z44z c Other
I hereby acknowledge that I harp reed thle apple alfon and sWft that the above lnfmff dm Is complete and eonec# I agree to
comply with all repuiremerft contained herein and city kwdina x= and stato laws regulating building eonstructlon. I know that a
penmlt Is not vatid until k has been paid and issued.
Applleanb
printmeme: D.a.�.e signatum Data