HomeMy WebLinkAbout509 Shadbury Ct - Applications/Reroof - 09/20/2011Sep 20 11 01:52p 5 Star Roofing Co,,LLC 970-663-7827 p.1
City, of Planning, Development & Transportation
} 281 N. College Ave P.O. Box 580
For` Collins 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 O Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application.
Application #—I%0%S77
For afte u e only
Incomplete applications will not be accepted.
Date
Job Site Address (required)
5oq Shan bu.ry
Value of Construction (labor, materials, profit)
a4m. OD
Property Owner Name Address
S ctrctih Fe-l-f-r SC 9 Shad ► LLr
City/State Zip Phone
Ci- F+ Cc 1 l t i� S CO (90
.
Applicant Name Address
5 stair �ol?l (�1 C.o .1_1_C 1',Voow .
City/State Zip Phone
1 _- Ian co &�Dr7 lP t99D- o l I c)
Contractor Address
City/State Zip Phone
5 Sias Lt_L' C \N
Co Sob? (nln?)--ol t o
Contractor City ot. Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here WReport
sales&wnumber esrequired byall mndactors
Are you paying with your trust account? )( Yes ❑ No
Is this a residential or commercial project? ❑ Residential ❑ Commercial
If residential, is it: A14Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ 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? ❑ Yes ❑ No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Ifprior to 1975, you will need an asbestos assessment to submit with this application.
Of
Tu iawn spnnaer/backncw preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Gist the company name orClyorFt Collinslic�enst? # �r11
Bectrician Plumber Mechanical Roofer R- �" O 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 ordinar\ces and statl laws regulating building construction. I know that a
permit is not valid until it has been paid and issued.
i
Applicant: hq/
Print Name:Ck, n Signature Date Date ZO�_l,____