HomeMy WebLinkAbout2620 Country Squire Ln - Applications/Reroof - 10/21/2014City/ of Planning, Development & Transportation
281 N. College Ave P.O. Box 580
F6r`} Collins 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) ❑ 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 applicable information on the application. Incomplete applications will not be accepted.
Application # Date 10/21/2014
Foroffice use only
Job Site Address (required)
2620 COUNTRY SQUIRE YffiV
Value of Construction (labor, materials, profit) 4000
Property Owner Name
TIM KUHLMAN Address
City/State Phone 970-310-6666
Applicant Name
PERLA ORNELAS Address
City/State Phone 970-352-9988
Contractor
TOTAL REMODEL CONTRACTOR Address 2006 81 ST City/State GREELEY/CO Zip 80631 Phone
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? a4 Here ❑ Report
Salestaxnumberisrequiredbya//contractors
Are you paying with your trust account? a Yes ❑ No
90-0736417
❑
Is this a residential or commercial project? X Residential ❑ Commercial
If residential, is it: X Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If 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 X No Ifyes, youmayneedtocontactHistoricPreservation
If this is for a demolition permit, what year was the building constructed?
Ifpriorto 1975, you willneedanasbestosassessmenttosubmitwith thisapplication.
Description of work RE ROOF DOWN TO DECK W OWENS CORNING DURATION SHIGLES ON AA STORY
HOMF 21 Sn
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the companyname or City ofFt Collins license #
Electrician Plumber Mechanical 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 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: PERLA ORNELAS Signature Date 10/21/14