HomeMy WebLinkAbout4737 Crest Rd - Applications/Reroof - 10/31/2014id3s
City of
Fort Collins
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 Trot service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home 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 applicableInformation on the application. Incomplete applications will
not be accepted
Application # �� 1 D,3 V Date to L31 (al-6I LI
For office use only
Job Site Address (required)
Value of ConstrucVn (labor, materials, profit)
t-5� C' `42sC
% S •
%
Property Owner Name Address
City/State Zip
Phone
IMAMS C S� 1P -saw►
Appl ant Name Address
i City/State Zip
Phone
Contractor Address
City/State Zip
Phone
CAPITOL ROOFING INC. 6540 S. COLLEGE
FORT COLLINS 80526 970-223-5600
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? tg Here
❑ Report
sales tax numterisreouiredbyall contractors.
Are you paying with your trust account? ❑ Yes
gR940
Is this a residential or commercial project? EX -Residential ❑ Commercial
If residential, is it: M�Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ElHotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building So years of age or more? ❑ Yes fijNo if yes, you may need to contact Historic Preservation I
If this is for a demolition permit, what year was the building constructed?
Itprior to 1975, you will need an asbestos assessment to submit with this application.
I
Description of work v-D- t 2) V1I e u�x ". -
r6 Shred-c� —.-
3(o
.If lawn sprinkler/backnow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Cist the company name or City of Ft Collins license 0 -f\l %S
Electrician Plumber
Mechanical Roofer Other
r
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: Date
Print Name: CAPITOL ROOFING INC Signature J4_