HomeMy WebLinkAbout513 Ramah Dr - Applications/Reroof - 11/14/201111/14/2011 12:28 9703305645 SLAUGHTER ROOFING PAGE 05/06
City of� a
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 O Lawn Sprinkler ❑ Mobile Home replacement O Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line O 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
Job Site Address (reWvad)
Value of Construction (labor, materials, profit)
13 OS
Q0
Property Owner Name Address
City/State Zip Phone
51
SZ -(0(04
Applicant Name Address
City/Stage Zp Phone
G
Contractor Address
City/State Tip Phone
2120 Cuievo t)sE
o 1
Contractor City of Ft. Collins Sales Tax It
Are you paying taxes here or by report? PA Here O Report
sales,tax number Isrequired byaffcontmetom
Are you paying with your trust account? 0 Yes ❑ No
is this a residential or commercial project? El Residential ❑ Commercial
If residential, is it: IF Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
O 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? O Yes J4 No ffyes, you may need to contact ifistcr/cPreservation
If this Is for a demolition permit; what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work
3:5 So
*If lawn sprinkler/backflow preventer,,must list licensed plumber. If first-time A/c, must list licensed electriclaV.—
Subcontractors: Ust the campany name or C/ly of Ft Collins license 0
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:
Print Name:/ -C � Signature
Date 11I �I