HomeMy WebLinkAbout2530 W Stuart St - Applications/Reroof - 10/20/2014Oct.20. 2014 10:50AM Bob Behrends Roofing
No. 3118 P. 1
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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 (not service change) El Gas Lighter El Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line 17 Wood/Pallet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # Date
Forofdce use only
Job Site Address (requ/red
Value of Construction (labor, materials, profit)
Property Owner Name C�Uv�S� Ad ess
City/State ZIP
Phone
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Applicant Name Address
City/State Zip
Phone
Contractor Address
Clty/State Zip
Phone
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by rep rt?
Here ❑ Report
sblea fax nwn a !s\reQl b
Are you paying with your trust account?l
Yes ❑ No
!contractors
Is this a residential or commercial project?"N Residential Q Commercial , S�br
If residential, is !J' ' Single Family Detached ❑ Condo/townhome (single family attached) Q Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, Is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
Ll Restaurant ❑ Other (explain)
❑ Ye
Is this building 50 years of age or more? s�o Ifyes, you may need to contact HlsbricPreservat/on
If this Is for a demolition permit, what year was the building constructed?
Ifprlor to 1975, you will need an asbestos assessment to submit with this application.
*If lawn sprinkler/backflow preventer, must list licensed plumA. If first-time A/C, must list'licensed eiectrki Cow
5ubcontractars: Llst the company name or City of FtColl/nsl/cense
EleCtndan Plumber Mechanical Roofer. C\ \�1� 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: \( r h
Print Name: \ `�C) r �'�z C 2 � s Signature Vim\ Date