HomeMy WebLinkAbout709 Crown Ridge Ln - Applications/Reroof - 06/12/2012- 06/12/2012 03:42 3032384051
, City of .03
Flirt CoLlinS
INTERSTATE ROOFING
PAGE 01/04
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 Cl 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 # r-l'J 3-7 0 3 Date (dL/Z'J/ Zr
For offlce use only ` "1 . Q I
lob Site Address (required) Value of Construction labor, materials, profit)
v 07
Property Owner Name Address City/State Zip
Phone
y J FA c hos Cin SaZIS
y 8/- 84�'39
Applicant Name Address City/State Zip
Phone
o c- RPcA /)/05'4 W -44(7 vee G4 pa? /! 3
77S-d'-2G 0
Contractor Address City/state Zip
Phone
Jttooi vt ?D 4:�Q j60911
3 7
Contractor City of Ft. Collins Sales TO # Are you paying taxes here or by report?. sere If ❑ Report
Sales tax number is required by allContraetors. Are You paying with your trust account? ❑ Yes
Joo
Is this a residential or commercial project? ❑ Residential ❑ Commercial
If residential, is it: ❑ Single Family Detached &N�Zondo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
El Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes R:' o If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year waste btu !ding constructed?
ifpnor to 1975, you w111 need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft coffins license .#
Electrician 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: f�
Print Name: ��� (�► +r-- Signature Date 1 L