HomeMy WebLinkAbout1220 Truxtun Dr - Applications/Reroof - 09/20/201109/20/2011 08:58 9703305645
SLAUGHTER ROOFING
PAGE 02/06
Planning, Development &'transportation
Z81 N. College Ave P.O. Box s8o
Fort Collins, CO 00524
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). 0 Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter El Gas Log
❑ Heating Unit O 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 application. Incomplete applications will not be accepted.
Application # I Ito `� COA
For office use only
Date_
lob Site Address (mquited)
Value of Construction gabor, materials, profit)
0 cis
`�41300 0o
Property Owner Name Address
City/State Zip Phone
Applicant Name Address
City/State zip Phone
MICA sL= W rwSlA
1
Contractor. Address
City/State Zip Phone
SL"ff 0— YmEld—Gi CO 2MO C 0%
0 1
Contractor City of Ft, Collins Sales Tax #
Are you paying taxes here or by report? Here ❑ Report
saleslaxnumber;rrequlredbyalicontactors.
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Are you paying with your trust account? 04 Yes ❑ No
Is this a residential or commercial project? Z Residential ❑ Commercial
If residential, is it: g Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office O Retail
❑ Restaurant ❑ Other (explain)
Is this building 5o years of age or more? O Yes RJ No Ifyes, you may need to contact Hlstcr/cPreservation
If this is for a demolition permit, what year was the building constructed?
Ifpnor to 197S, you wit/ need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of R Collins license f
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:— signature
Date_Zo��/