HomeMy WebLinkAbout6512 Southridge Greens Blvd - Applications/Reroof - 06/15/201206/14/2012 22:e4 9703539774 INDEPEDENT ROOFING I PAGE 01
City of
Fort Cairns
Planning, Development &'Transportation
281 N. College Ave P.O. Box 560
Fort Collins, CO A0524
Phone 970-416-2740 Fax 22+6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to appiy•for the following permits only (check all that apply). ❑ Air Conditioning
❑ Demolition (interior non-structural) 0 Electrical Alteration (not service change) ❑ Gas Lighter 0 Gas Log
❑ Heating Unit 0 Lawn Sprinkler ❑ Mobile Home replacement XRooling ❑ Sewer Line. 0 Photo -voltaic
❑ Ventilation Q Water Heater ❑ Water Line ❑ Wopd/Peliet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information ontheapplication. Incomplete applications will not be accepted.
Application # �D� 13 . Date _(Q�
For ot9ice use only
Job Site Address ( ed) U.cJ - value of Construction (labor, materials, profit)
-41
Pm rty Owner Name Address Gtylst'at'e Zip Phone
77
Applicant Name U Address Gty/State Zip Phone
Same
Contractor uc#R294 Address Crty/State Zip Phone
i' I Independent Roofing Inc.. 405 22nd St.., Greeley, CO 80631 970-;-35 -7389
IContractor Crty of Ft Collins Sales Tax # Are you paying taxes here or by report? ❑ Here �0 Report
SBI MynwnGerh regtdredbyaffWn a=M Are you paying with your trust account? M Yes 0 No
Is this a residential ontornerdal project? ® Residential ❑ Commercial
if residential, is It 13 Single Family Detached ❑ Cbndo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Gierage
If commer•rial, is tt ❑ Bank ❑ Bar ❑ Church 0 Hotel/Motel • ❑ Medical Office ❑ Office ❑ Retail
❑ Restaurant E3 Other (explain)
Is this building 50 years of age or more? 0 Yes . eNo IfyPs, you may need to tonbitHrstprlcPresenraflon
Vthis is for a demolition permit, what year was the building constructed?
Zpnor to 1975, you will need an asbesins asq�entto submit wib4 this applicatio17.
of work
*If lawn sprinkler/bacldiow preventer, mast fist licensed plumber. If fast -time A/C, must: list licensed electrician.
Sulxont aebom )Jet yre company name or DZy of Ft Ca6las. Adw se 4F
gixbiclan plumber Macuankal Rooter ? 1 _ Other
i I hereby acknowledge that I have read this application and state that the above information is complete and cornett I agree to
amply with all requirements oaritained herein and city. ordinances and state laws regulating building cansduction. i know that a
permit is not valid until it has been paid and issued.
Applicant
Print Name: ( try, rLi Y1 l P lC SignatutE f . Date_