HomeMy WebLinkAbout4286 Stoneridge Dr - Applications/Reroof - 05/23/2012 (2)May 23 12 10:25a SLAUGHTER ROOFING 9703305645 P.
=, C; i )! o
tiu,:`•'• ill, ' �- �i :;.; . ,
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 ❑ 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 applicable information on the application. Incomplete applications will not be accepted.
Application #___1N I oa--O Date
For office use only
lob Site Address (required)
Value of Construction (labor, materials, profit)
d0
Property Owner Name Address
Gty/State
Zip Phone
Applicant Name Address
City/State
Zip Phone
7A
- )
Contractor Address
City/State
Zip Phone
21Zo C
0 1
Contractor City of FL Collins Sales Taos #
Are you paying taxes here or by report? Here 0 Report
salV,101N mnerrsre7u%redbrallMVRmrs
Are you paying with
your trust account? DO Yes ❑ No
F—
Is this a residential or commercial project? 0 Residential ❑ Commercial
If residential, is it: IR Single Family Detached ❑ Condo/town home (single family attached) 10 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 j1i3 No zfyes, you may need la contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?.
Ffprlor to 1975, you wi/1 need an asbestos assessment to submit with this apprcation.
Desa-iption of work
*If lawn sprinkler/Iaddlow preventer,. must fist licensed plumber. If first time AJC, must list licensed electrician.
Subcontractors: list the company name or City ofR Collins license #
Elecbfclan Plumber Mechanical Roofer Other
I hereby acknowledge that I have read this appricatidn and state that the above information is complete and correct. I agree to
comply with all requirements contained herein and city ordinances and state taws regulating building construction. I know that a
permit is not valid until it has been paid and issued:
Appricant: PrintName: ( / PA IAyzdT_�� Signature
Date SJZ3�/2