HomeMy WebLinkAbout4907 Clarendon Hills Dr - Applications/Reroof - 08/27/2014Rug 27 2014 12:02PM HP LRSERJET FAX
1970-267-9005 P.1
�=ort of.
Planning, Development &Transportation
261 N. College Ave. P.O. Box 5110
Fort Collins,
Phone 970-41616-27402740 Fax 2246134
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) 0Gas Lighter ❑ Gas Lag
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Horne 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 ostL" Date &P77-114
For ofte use only
Sob Site Address (requ/red)
Value of Construction (labor, materials, profit)
41%-1 daamJ' tn
W . CID
Property owner Name Address
Ctty/State Zip
Phone
'4407
Gn8
- '
Applica t Name Address
City/State Zip
Phone
Po Box 1326
Ft. Collins 80522
9705661884
Contractor Address
City/State Zip
Phone
Ticos Roofing Inc Po Box 1326
Ft. Collins 80522
9705661884
Contractor City of Ft Collins Sales Tax #
Are you paying taxes here or by report?
M Here ❑ Report
Sales tax number isrequlmdbya/lcontradom
Are you paying with your trust account?
❑ Yes ❑ No
R-1686
Is this a residential or commercial project? IN Residential ❑ Commercial
If residential, Is it: 0 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 5o years of age or more? ❑ Yes ICNo rf yes, you may need to contact HistoricVresetwtlon
If this is for a demolition permit, what year was th building constructed?
If prior tv 1975, you will need an asbestos assessment to submit w/M th/s appl/cation.
of work Tear off to decking & replace w/ asphalt shingles Provide required vents
*If lawn sprinkler/backilow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Ust tim company name or Cry of Ft Collins license #
Electrician Plumber Mechanical Roofer R-1686 Other
I hereby acknowledge that I have read this application and state that the above Information Is complete and correct. I agree bo
comply with all requirements contained herein and city ordinances and state laws regulating building. construction. II know that a
permit Is not valid until it has been paid and issued.
Applicant:
Print Name. o�,�
Date R1, 7—t9