HomeMy WebLinkAbout838 Napa Valley Dr - Applications/Reroof - 09/20/201109/20/2011 06:58' 9703305645 SLAUGHTER ROOFING PAGE
Cityof Planning, Development & Transportation
� 281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
_ 4• � (i ''�
Phone 970-416-2740 Fax 224-6134
� OVER-THE-C UNTER 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 0 Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing Cl Sewer Line ❑ Photo -voltaic
❑ Ventilation 4.Water Heater ❑ Water Line ❑ Wood/Pellet to MUST1019 E A certified, provide make, model and
manuratio
,{(—
Compp mplete applications will not be accepted.
Appl� - IQ! b dF` Y D e r T-I 7,(y_� 11
For office use only
05/06
Sob Site Ad
4alue f Construction (labor, materials, profit)
Property Owner Name
Address
City/State Zip Phone
A-
93% p
ca S o-210- V1 I
Applicant Name
Address'
City/State Zip Phone
1 L G
7b Bytotisb py-
+ (910)330--n91
Contractor
Address
City/State Zip Phone
2t?A C IiSfin
soum LT03301
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? )S( Here 0 Report
�g� berisrequfredbyall contracmrs.
Are you paying with your trust account? if Yes ❑ No
1
Is this a residential or commercial project? 0 Residential ❑ Commercial
If residential, is it: IX Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office O Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes )93 No Ifyes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you w/l/ need an asbestos assessment to submit with thls application.
Description of work
*If lawn sprinkler/backflow preventer,• must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: t.fst the company name or Qy of Ft Cofllns 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: CC
PrintName:_C.b�,, (>j RIXAkTF.R- Signature
Date _ -I / Ln / I/