HomeMy WebLinkAbout5109 Parkway Cir - Applications/Reroof - 11/14/201403/03/2014 22:06 9705872178
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MASTER ROOFING CO
PAGE 02/03
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, OD 80524
Phone 970-416-2740 Fax 224.6134
OVER-THE-COUNTER PERMITS ONLY
This appl ration la to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
❑ Demoliti3n (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter CI Gas Log
❑ HeatinE Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Rooting ❑ Sewer Line ❑ Photo -voltaic
0 Ventilat on fJ Water Heater ❑ Water Line ❑ Wood/P61W Stove (must be EPA certified, provide make, model and
--manufact i er).
Complete all appiioable information on the application. Incomplete applications will not be accepted,
AppllCau: n # Date 10`may/ 0
Forobus vwe a*
lob Site / l ddt esa v aried) Value of Construction gabor, materials, profit)
011 Name Address City/Ste Zip Phone
erne f Address /State - Zip Phone
- 5;=^
/ �—
or 1101
. / _ �#;d��Address.. city/state
,. Zip •i Phone _
Corltra ±0r :;itjv of Ft. Collins Sales IWO# .—
Are you paying taxes here or by report?
0 Here
❑ Reptnt
Saks 4wnun.irertsveq&rWbya#CX*aatM
Are you paying with your trust account?
❑ Yes
❑ No :
Is this a res 1 k ntial or merclal project? Idential ❑ Commercial
If residentia Is it Fngle Family Detached 13 Condo/townhome (single family attached) 0 Duplex
uItnmily (apartment) ❑ Garage
If commerd 11, is It: ❑ Bank 13 Bar 0 Church 0 Hobel/Motel ❑ Medical office tp Office ❑ Retell
0 Restaurant ❑ Other (explain)
Is this bulldi ig 30 years of age or more? O Yes O Ne Ifym you maY1XWdt0 concoct H1&01fcPrV-sBvvab'on
If this Is for !, demolition permit, what year was the building constructed?
Ifpr/or in 1 !7.5 Ynu w/// need an asbaros azeRsownt to wbmff with th/s app/lcadon.
Descatptior of wont 1}
*If lawn sprh i.ber/back iaw prevent, must list licensed plumber. if first-time A/C, must list licensed electrician.
SullooMbad! mn: L/st ft awmpany name or 01y of Co///ns lkw me #
Elactridan`.
Plumber. Mechanical Roofer/" Other
I hereby adm! rvadge that I have read this application and state that the above information Is complete and coned. I agree to
comply with I I I i equirements contained herein and city ordinanaPs ' teJaws
permit Is no I valid until It has been paid and Issued. regulating building constnrctlon. I know that a
Applicant:J
Print Name"