HomeMy WebLinkAbout4267 Stoney Creek Dr - Applications/Reroof - 08/29/2014C of
F Collins
Planning, Development& Transportation
2B1 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone97041&-2740 Fax224-6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). Cl Air Conditioning
❑ Demol-than (ntedar non statcturao ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Spdnlder O Mobile Home replacement 12 Roofing ❑ Sewer tine D Photo-voltaf :
CI Ventilation ❑ Water Heater ❑ Water Line Cl V4bodlPellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information ooia the application. Incomplete applications will not be accepted.
Application # �d °� ®� ®®�' Date oar2am14
farar" use only
Job Site Address rregxoad)
Value of Construction (labor, materials, profit)
4267 STONEY CREEK OR.. Fr COLLINS, 0080525
167f4.00
Property Owner Name Address
City/State Zip Phone
EVERGREEN PROPERTY MANAGMENT 1000 DRIFTWOOD DR, F r COLLINS, CD 80525 9710-2265600
Applicant Name Address
Gtylstate Zip Phone
Contractor Address
City/State Zip Plxme
ROOF WORM, LLC 12301 N GRANT ST., STE 130 THORNTON. 00 80241 303353-f825
Contractor Clty of Ft Collins Sales Tax #
Are you paying taxes here or by report? 0 Here J, Report
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Are you paying with your trust amount? ❑ Yes 93 No
50640
Is th-s a residential or commercial project? BI Residential ❑ Commercial
if residential, is it: 13 Single Family Detached ❑ CondoRawnhome (single famlty attached) ❑ Duplex
❑ Mulrlfamily(apartment) ❑ Garage
If commercial, is it ❑ Bank ❑ Bar ❑ Church ❑ HatelfMotel El Medical office ❑ Office 11 Retail
❑ Restaurant 17 Other (explain)
Is this building 50 years of age or mare? ❑ Yes M No Ifyrs, ym„nayneed m caTb¢Y NFstw cPresaruat cs1
If this is for a demolition permit, what year was the building constnrcted?
lfpr�e-G� 1975, ytxr rvuyneedaa as�tosacssessrnartto su6mlt write Cher appJicdtfon
Description of work RFrAoyE xisTTNc- sHlNcLF ANn RFPI nrr W171 (,QSOLIARFC OF CAF TIN RFB1 INE NATURAL
*If lawn sprinkleybaddlow preverder, most list licensed plumber. If fist -time A)C� must list licensed electrician.
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Dlunlo Ncdlaniral RooW R-2166 Other
I heresy 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 builft construction. I lmowthata
permit is not valid until it has been paid and marred.
Applicant:
Print Name: EOWARDTHOMAS Signahrreate QRM7 2014
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