HomeMy WebLinkAbout5025 Bluestem Ct - Applications/Reroof - 07/23/2014Jul 24 14 06:39a Westers Roofing
9705688448
Planning, Development & Transportation
City of 281 N. College Ave P.O. Box 580
� r't Collins Fort Collins, 8
Phone 970-41616-2740 34
740 Fax 224-61
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 ❑ Roofing ❑ Sewer Line D Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ 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.
Application'# ��'L��4 Date CH '
90
c',e AA7ro rl M/V
Job site Address (required)
Value of Construction (labor, materials, profit)
s0 ZS
Lt 4-
Property Owner N me
Address
City/State
Zip Phone
Applicant Name
Address
city/State
Zip Phone
9 o-boo-�B
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Contractor
Address
City/State
Zip Phone
M
Contractor City of R. Colli s
Tax #
Are you
paying with your trust
account? 0-Yes 0No
SW&S tdK wnberis reqtdredbyaPambacto #0877
Is this a residential or commercial project? 4 Residential ❑ Commercial
If residential, is it: Single Family Detached ❑ Condo/townhome (single family attached) 0 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 IVlo if yes, you may need to contat HlsWric Pmse"tfan
If this is for a demolition permit, what year was the building constructed7
ff priorto1975, you will need an asbestos assessment to submit with this app/lcatfon. r'
Description of work
4
*If lawn sprinkler/baddlow preventer, must list licensed plumber. if flrst-tlme AJC, must list Iiceensed electrician. S ��
Subcontractors: W the company name or City of Ft Collins Ilene #
Sectridan Plumber Mechanical Roofer 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, L. . Sgnatu (/ate —7 "Z 3- Y
Print Name:_-7 _
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