HomeMy WebLinkAbout2614 Stonehaven Dr - Applications/Reroof - 08/07/201408-05-'14 12:32 FROM -Premier Roofing 9704848308
T7190 P0004/0007 F-399
Planning, Development & TransportattOn
cit f For N. Collins,ColleCo80 P.O. Box 580
Fort llins, O 80524
Phone 970-416.2740 Fax 224-6134
OVER-THErCOUNTER 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) d Electrical Alteration (not service change) 0 Gas lighter 0 Gas Log
❑ Heating Unit 13 Lawn Sprinkler 0 Mobile Home replacement 0 Roofing V Sewer Line O Photo -voltaic
0 Ventilation ❑ Water Heater O Water Line E3 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
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Dater _W
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Job Site Address Nqulred) value of Construction (labor, materials, prof
Pr Y perry Owner Name Address City/State Zip Phone
Applicant Name Address City/State Zip Phone
Contractor Address Lai state Zip Phone
Contractor City of Ft. Collins SaI4 Tax # Are yo aying taxes here or by report? N-HQFe 0 Report
.sawAwnumberIsregLftdbya#avntrxftx Are you paying with your trust account? 0 Yes 0 No
Is this a residential or comm al project? MlGidential 0 Commercial
If residential, is it: ngle Family Detached 0 Condo/townhome (single family attached) 17 Duplex
0 Multifamily (apartment) O Garage fib^
If commercial, is it: 0 Bank 0 Bar 0 0 Church Hotel/Motel 0 Medical office 0 office ❑ Retail W
0 Restaurant ❑ Other (explain)
Is this building 50 year: of age or more? O Yes o tf)aF You I»aynftd fo mMact MBtorh: Avsvwf cn
If this is for a demolition permit, what year was the building constructed?
Ifpviar to IM, you W11 need an asbestos amepsrnent to submit with this app&atlun.
Descri tion of work
*If lawn Inkier/backfiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: L/st the company name or ply of R Cb&w &Vnsa 0
Dectridan 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.
Print Name
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