HomeMy WebLinkAbout2801 Crystal Ct - Applications/Reroof - 11/09/201111/09/2011 14:40 9703305645 SLAUGHTER ROOFING PAGE 03/05
Planning, Development & Transportation
City of� 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). 0 Air Conditioning
❑ Demolition (interior non-structural) 0 Electrical Alteration (not service change) ❑ Gas Lighter 0 Gas Log
❑ Heating Unit ❑ Lawn Sprinkler 0 Mobile Home replacement 0 Roofing ❑ Sewer Line 0 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 #
For office use only
Sob Site Address pegLffmd) Value of Construction (labor, materials, profit)
Z D I L C 00
Property Owner Name Address w City/State Zip Phone
Address City/State Tip Phone
Applicant Name _
Contractor - Address City/state Zip Phone
Contractor City of R. Collins Sales Tax # Are you paying taxes here or by report? lP4 Here ❑ Report
Are n with our trust account? 01 Yes ❑ No
sates, tax numberis required by all contractbrt'' you paying � y y
is this a residential or commercial project? $I Residential ❑ Commercial
If residential, is it IR Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank Cl Bar ❑ Church ❑ HOtel/Motel ❑ Medical office ❑ Office ❑ Retail
I] Restaurant ❑ other (explain)
Is this building 5o years of age or more? ❑ Yes A No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If priar to 1975, you w///need an asbestos assessment to submit wiPh tills application.
of work
*If lawn sprinkler/backflow preventer,,must list licensed plumber. If first-time A/C, must list licensed electrician.
subcontractors: List thO company name or OZY of ft Colllns 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: Ac
Print Name: Signature
Date