HomeMy WebLinkAbout1924 Dakota Ct - Applications/Reroof - 10/09/2014City of
Fort Collins
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 (riot service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ® Roofing ❑ Sewer Line ❑ 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
the application. Incomplete applications will not be accepted
Application # 14 4 1 I_ `y Date t �� Z V
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
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s co zsl- 4,500.3
Property Owner Name
Address
2y Dakolu
City/State Zip Phone
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Applicant Name
Address
City/State Zip Phone
Contractor
Address
City/State Zip Phone
CAPITOL ROOFING INC.
6540 S. COLLEGE
FORT COLLINS 80526 970-223-5600
Contractor City of FL Collins Sales Tax #
Are you paying taxes here or by report? �k Here ❑ Report
Sales tax number is required by all contractors.
Are you paying with your trust account? ❑ Yes RfNo
cy-)05l5�n `,¢
Is this a residential or commercial project? OO Residential ❑ Commercial
if residential, is it: J.Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
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if commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building So years of age or more? ❑ Yes--�k3/No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed? i
If prior to 1975, you will need an asbestos assessment to submit with this application.
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Descripbon f work \h--Z- i _�N Kt a 1^
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'If lawn sprinkler/backnow preventer, must list licensed plumber. if first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City Of RCollins license fi tv krl'rie�
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
is not valid until It has been paid and issued.
permit
Applicant: Date
Print Name: CAPITOL ROOFING INC Signature — I
61