HomeMy WebLinkAbout1345 Salem St - Applications/Reroof - 08/15/2014Drury Bros Roofing Denver
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Flirt Collins Y
3032748602 p.1
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134I
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
0 Demolition (interior non-structural) ❑ Electrical Alteration (not se ice change) ❑ Gas Lighter ❑ Gas Log
0 Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement JXRoofing ❑ Sewer Line ❑ Photo -voltaic
0 Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Sto a (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # lb 14 V(0 �q_S Date
For office use only
Job Site Address (regvf=9
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Value of Conn (labor, materials, profit)
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Pro rty Owner Name
Address City/State
Zip
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Address City/State
Zip
Phone
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Address City/State
Zip
Phone
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627/ 901,
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report?
Mere 0 Report
Saks tax number is required byWlconrracrors
Are you paying with your trust account?
❑ Yes CtY alb
Is this a residential or commercial project? Residential ❑ Commercial
If residential, is it: @35ingie Family Detached 0 Condoltownhome (single family attached) 0 Duplex
0 Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church 0 Hotel/Motel ❑ Medical office ❑ office 0 Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes o Ifyeyoyou maynead to conta&HstodcPresen+adon
If this is for a demolition permit, what year was the building constructed?
Ifpnor to 1975, you will need an asbestos assessment to submit iWth this applirabon.
of work
*If lawn sprinkler/badcFlow preventer, must list licensed plumber. If first-time MC, must list licensed electrician.
Subcontractors: list the company name or Gty of Ft Collins %tense #
Electrician Plumber Mechanical Roofer IS 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. ,
Applicant: J /�
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Print Name: 'i'C, p_ I l - - Z31�
Date �_