HomeMy WebLinkAbout6403 Buchanan Ct - Applications/Reroof - 08/23/201208/23/2012 08:11 9705930124 GOLD ROOFING INC PAGE 01/01
City, of
Flirt COttins
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 (not service change) 0 Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ lawn Sprinkler O Mobile Home replacement Roofing ❑ Sewer Line ❑ Photo -voltaic
0 Ventilation 11 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 # T21 G-V [ Date
Far ofte use only
Is this a residential or commercial project? iN Residential ❑ Commercial
If residential, is it: DESingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Sank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office 0 Office ❑ Retail
11 Restaurant ❑ Other (explain)
Is this building So years of age or more? ❑ Yes O No If yes, you may neeG to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
ff prior to 1975, you will need an asbestos assessment to submit with this applicaVon.
Description of work
*If lawn sprinkler/backflow preventer, must fist licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City Of Ft Collins license #
eecWdan 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: J
Print Name: J// 0n s , q + a Signature �//--- Date �2 f j ;2