HomeMy WebLinkAbout2348 Kodiak Rd - Applications/Reroof - 10/01/2014�-10/01/20.14 2:47PM FAX 30342009B7
PROFESSIONAL ROOFING
0 0001/0002
City of
cart Collins
Planning, Development & Transportation
281 N. College Ave P.O. Sox Sao
Fort Collins, CO 80524
Phone 970-416-274o Fax 22+6134
OVER-THE-COUNTER PERMITS ONLY
This application Is to be used to apply for the following permits only (check all that apply). 13 Air Conditioning
❑ Demolition (interior non-structuraq O Electrical Alteration (not service change) ❑ Gas Lighter D Gas Log
d Heating Unit M Lawn Sprinkler O Mobile Home replacement ❑ mooting ❑ Sewer Line ❑ Photo -voltaic
O 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 # KL-ts- `�
Date
For of v use only
Job Site Address
Property Owner Name
Contractor City of Ft. Collins Sales taI
Sales bornumber�regtdl�+d by al/mntractav�
Value of
Address
materials, profit)
Phone
Address state Zip '-Warne
Address City/ be Zip one
jj
Are you paying taxes h or by report? ❑ Here !
Are you paying with your bust account? ❑ Yes 0 No
Is this a residential or c9mmerclal project? 01tesidential p Commercial
If residential, is it: V Single Family Detached 17 Condo/townhome (single family attached) ❑ Duplex
13 Multifamily (apartment) ❑ Garage
If commercial, is It: 0 Bank 13 ear 0 Church ❑ Hotei/Motei ❑ Medical office Q Office ❑ Retail
17 Restaurant 13 Other (explain)
Is this building 50 years of age or more? 13 Yes g-No Ifyos4, ytw may need to contact H[St WC PmswmbLn
If this is for a demolition permit, what year was the building constructed?
lfpfor to 1975, yno W11 need an asbastas aoR meet to submit rr/th this application,
work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subamrtraet nail List the company name or Uiy of l4 Gbl/irfs bagm e g
Elecvklan Plumber. Methanlml Roofer Other
I hereby admowledge that 1 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
s