HomeMy WebLinkAbout521 Shadbury Ct - Applications/Reroof - 02/03/201502-03-'15 10:55 FROM -Premier Roofing 9704848308 T-276 P0002/0002 F-558
of
. Dort Collins
Planning, Development & Transportation
281 N. College Ave P.t). Box 5110
Fort Collins, CO B0524
Phone 970.41.6-1740 Fax 224.6134
OVERoTNE-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) d Gas Lighter 0 Gas Log
0 Heating Unit 0 Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing 0 Sewer Line ❑ Photo-voltaio
CI Ventilation 0 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 # 0 1.
Date
For ofte use only
Job Site Addren (requ/md)
Value of Construction (labor, materials, profit) 30RE
Property Owner Name Address
City/State Zip Phone
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Applicant Name Address
City/State Zip Phone
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Contractor Address
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City/State Zip Phone
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Contractor City of R. Colll s Sales Tax # Ar
you paying taxes here or by report? &95re ❑ Report
WistwoumberIsmqulmdbyall conbucto s. Are you paying with your trust account? ❑ Yes Ci,No
Is this a residential or conVwcial project? Residential 97 Commercial
If residential, Is it: Mingle Family Detached i3 Condo/townhome (single family attached) 0 Duplex
17 Multifamily (apartment) 17 Garage
If commercial, is it: 17 Bank 0 Bar ❑ Church 0 Hotei/Motel Ci Medical office ❑ O(Bce 0 Retail
13 Restaurant 17 other (explain)
Is this building 5o yea►s of age or more? ❑ Yes Ify65, you mayneed M contactHislbricPraserwaHon
If this is for a demolition permit, what year was the building constructed?
lfpn`or to 1975, you w/l1 need an asbeslrxs asseamentto submit wlhh this application.
lawn sprinkler/backilow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: ilstthe company nameOrLilyofFttbll/nSIfewse #
Elecirlcian plumber_ _ Mechanical Roohr 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:•,,�D� 1' • 1 fri l � _— &ignatu►e l�/; t � �Vdt® _
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