HomeMy WebLinkAbout5012 Bluestem Ct - Applications/Reroof - 08/11/2014Cityof Planning, Development & Transportation
281 N. College Ave P.O. Box 580
For l} Collins 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 KI Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and '17�
manufacturer).
Complete all applicable Information on the application. Incomplete applications will not be accepted.
Application # 6- WS-1 i`1 Date
For olhce use only
Job Site Address (required),
r Value of Construction (labor materials, profit)
i
612. AS l�
r6 0_61 MIS 0 Q SZS I SS q . cos
Property Owner Name
Address City/State Zip Phone
P-41i i
60IZ v-C yW, i!_-A u;,s V%75 i7b 31 - L S
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? XHere ❑ Report
❑ Yes
SalC0esttaaxsu� isrequired byall contractors.
Are you paying with your trust account?
,<Noca
Is this a residential or commercial project? ,Residential ❑ Commercial
If residential, is it: PT -Single 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 WNo If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
of work
*If lawn sprinkler/backilow preventer, mu§t list licensed plumber. UArst-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license #
Electrician Plumber Mechanical Roofer QM• 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: /� l i
Print Name: CAPITOL ROOFING INC. S. nature Date