HomeMy WebLinkAbout4407 San Remo Cir - Applications/Reroof - 08/25/2014City of
Fort Collins
Planning, Development & Transportation
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 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 O 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 a�pplicable Informatio ion t 4e application. Incomplete applications will not be accepted
o #1 Application � ) (0� I Date
Fo,- office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
��p� Su►. �-CmoS (!,+►— � CnllinS � g6sz5 $2F�z.28
Property Owner Name Address City/State Zip Phone
I
G.o �a� San )r- C¢ltn 25 22 - 4913
Applicant Name Address City/State Zip Phone
Contractor
Address City/State Zip Phone
cAPiTOL ROOFING INC. 6540 S. COLLEGE FORT COLLINS 80526 970-223-5600
Contractor City of Ft. Collins Sales Tax Are you paying taxes here or by report? [Here O Report
Are you paying with your trust account? ❑Yes
sales tar number is required by afl contractors. OKNo
coc) C 134 (� j
Is this a residential or commercial project? C Residential ❑ Commercial
If residential, is it: Dingle 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 Coo If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
!(prior to 1975, you will need an asbestos assessment to submit with this application.
of work
n
.a • • - - I f tt �
*if lawn sprinkler/backflow prevente , must list licensed plumber. If first-time A/C, must list licensed electrician.
subcontractors: List the company name or City of Ft Collins license a Ji S Mt,Dw-r l
Elednpan Plumber -
Mechanical Roofer Other
I hereby acknowledge that I have read this application and state that the.above information is complete and correct. r dgier -
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:
ROOFING INC Signature
Print Name: CAPITOL
Date
I