HomeMy WebLinkAbout3707 Gullway - Applications/Reroof - 10/16/201410-16-'14 11:24 FROM -Premier Roofing 9704848308 T-241 P0007/0014 F-488
City}0f 281 N. College Ave P.O. Box 58D
rL Collins Fort Collins, co $0524
Phone 970.416�2740 Fax 224-6134
OVER-TH&COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (checkall that apply). 0 Air Conditioning
0 Demolition (Interior non-structural) 0 Electrical Alteration (not service change) 0 Gas Wheer 0 Gas Log
0 Healing Unit 0 Lawn Sprinkler 0 Mobile Home replacement 0 Roofing 13 sew Line 0 Photo -voltaic
1] Ventilation 0 Water Heater 0 Water Line ❑ Wood/Pellet Stove (must be EPA cer6fled, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applicationsvi l not be accepted.
Application #�
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lob Site Address lre4JAW
Name
Name Address
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Contractor Address
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Contractor City of Ft, Cogs Sales fair #
ire a tax number is relykad by ad mnbadw8,
Date
Value of constructlen (labor, materials, profit)
City/State zip MORE
City/State lip Phone
I 9 to Zp '' II Phone
Are you paying taxes here or by repart? 19oere 0 Report
Are you paying with your hest account? 0 Yes Ci No
Is this a residential or co ercial project? sidential 0 Commercial
If mwdenual, is It: r Ingle Family Detached 17 Cando/tawnhome (single famtly attarfied) C] Duplex
p Multifamily (apartment) O Garage n •
If eommerclai, is it: [3Bank Dear 13 Church ClWoteVMotel C7 Madlcal ofAce 0 Ofrte 0 Retail �(
D Restaurant 13 Other (explal -1
Is this building 50 years of age or more? 0 Yes o li�yes, youmayneertfio cnntad N/stoi/cPrssenraSon
If this Is for a demolition permit, what year was the building constructed?
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Ann
D iptlon of work r !ate
*If lawn sprinkler/ba&d1ow preventer, must list licensed plumber. If first-time A/C, must list licensed okctriclan.
Subcontnactorastlsttehecnmpenyname orCWofRCallbs/teem 0
Plumber_ Mechantral_� Roofer. Other
-
am hereby acknowledge that I have read this application and state that the above Informatlon is complete and correct- I agree t0
comply with all requirements contained herein and city ordinances and state laws regulating buNding construction. i know that a
permit is not valid until it has been paid and issued.
Applicant: Signature
Print Name:
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