HomeMy WebLinkAbout2701 Antelope Rd - Applications/Reroof - 07/31/2014Jul, 31. 2014 12:54PM Roof Works, LLC No. 0998 P. 3
CI Planning, Development & Transportation
Collins 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 ❑ Mobile Home replacement 0 Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater Q Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable Information on the application. Incomplete applications will not be accepted.
Applicatlon # b1/D 1'9 Date 07/31/2014 PJA•9D5
For ongae use only
Job Site Address (required)
value of Construction (labor, materials, profit)
2701 Antelope Rd.. Fort Collins, CO 80525
9231.00
Property Owner Name Address
City/State Zip Phone
Cindy 8 Jim Graham 2101 Antelope Rd. Fort Collins, CO 80525 970-282-9504
Applicant Name Address
City/State Zip Phone
Contractor Y Address
Clty/State Zip Phone
Roof Worx, LLC 12301 N Grant $t„ Ste 130
Thornton, CO 80241 363-353,1825
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? t!i Here ❑ Report
Sales lax number, lsmquIredbyall conb-acrors
Are you paying with your trust account? ❑ Yes ® No
50640
Is this a residential or commercial project? ® Residential ❑ Commercial
If residential, is it: IN Single Family Detached ❑ Cando/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 13 No If yes, you may need to contact Hlstorlc Pf wervallon
If this is for a demolition permit, what year was the building constructed?
If prior to 1975. you W11 need an asbestos assessment to submit with this application.
Description Of work Remove Existing Shingle and Replace with 28 squares of GAF Timberline HD
*If lawn sprinkler/badcflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician..
Subcontractors: Ust the company name or Q'ly of Ft Collins Ikense 0
Electrician Plumber Mechanical Roofer R-2165 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.
Applicants
Print Name: Edward L Th mas signature pate 07/31/2014