HomeMy WebLinkAbout5420 Roma Valley Ct - Applications/Reroof - 09/02/2014City of
Fit 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 4pot service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement KI Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete �ffra PILcable Inforrrfatror on tpe application. Incomplete applications will not be accepted j
Application- Date
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
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196.59 1
Property Owner Name
Address
City/State Zip
Phone
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Applicanilame
Address
U City/State Zip
Phone
Contractor
Address
City/State Zip
Phone i
CAPITOL ROOFING INC. 6540 S. COLLEGE
FORT COLLINS 80526
970-223-5600 I
Contractor City of Ft. Collins Sales Tax k
Are you paying taxes here or by report?
9-Here ❑ Report
by all contractors.
Sales tax n�er
Are you paying with your trust account?
❑ Yes ANo
� re Aire
Is this a residential or commercial project? &I -Residential ❑ Commercial
If residential, is it: L�Single 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 A No If yes, you may need to contact Historic Preservation
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.
`If lawn sprinkler/backllow preventer, musf list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license k T
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Flertnoan 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: CAPITOL ROOFING INC. Signature Date __ i
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