HomeMy WebLinkAbout4504 Seaway Cir - Applications/Reroof - 09/23/2014To: Planning and Development & Transport Page 6 of 10 2014-09-23 17:08:49 (GMT)
19706928189 From: David Perez
Using Own Employees and Please Mail Permit
'City Of Planning, Development & Transportation
F}�py{' 281 N. College Ave P.O. Box 580
IVA i IC011i S . Fort Collins, 0080524
Phone 970-416-2740 Fax 224-6134 % 00r s/
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) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement Mloofing ❑ 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 # 1$14010 ( Date
For office se only
9/23/2014
Job Site Address (required)
Value of Construction (labor, materials, profit)
4504 Seaway Cir Fort Collins CO 80525
10600
Property Owner Name Address
Oty/State Zip
Phone
Hare Tania 4504 Seaway Cir Fort Collins CO 80525
(602) 677-4934
Applicant Name Address
City/Stata Zp
Phone
Glenn Rennar 5489 Gulfstar Ct Windsor, CO 80528 9703917935
Contractor Address
Oty/State Zlp
Phone
Contractor City of R. Collins Sales Tax #
Are you paying taxes here or by report?
EtHere ❑ Report
,%lestax number ismquiredbyall contradors -'
" 00049405
Are you paying With your trust account?
R oYes ❑ No
Is this a residential or commercial project? ER(Residential ❑ Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
It commercial, is it: ❑ Bank ❑ Bar. ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes WNo lfyea you may need to contact HistoricHeseruatian
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application -
Description of work Reroof with a 50 year Gafelk Shingle 18 SQ 2 story
`If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time AIQ must list licensed electrician.
Sit bcont r act o rs: List the company name of Oty of R Collin Awnse #
mKhanlcal Roofer
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 dry ordinances and state laws regulating building construction. I know that a
permit is not valid until It has been paid and issued.
Applicant: 9/23/2014
Print Name: G1ei n Rennar Signature enn Rennar Date