HomeMy WebLinkAbout2319 Berkshire Dr - Applications/Reroof - 03/25/2015CitOf Planning, Development & Transportation
For `r}Collins Fort N. College Ave P.O. Box 580
/ `..- 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 # 1�)ISrj i8iq Date
For office use only
312s-11'�
Job Site Address (required)
Value of Construction (labor, materials, profit)
23101 pr•
4 2000 D0
Property Owner Name Address
City/State Zip
Phone
C,�I1r1S JAivrDY) 231'i 01WKSoirL
f+. C01Ii0Z, C0 %D52V
57'0- 27,0-1SAS
Applicant Name Address
City/State Zip
Phone
John Anderson PO Box 2207
Fort Collins CO 80522
970-223-2455
Contractor Address
City/State Zip
Phone
Severe Weather Roofing PO Box 2207
Fort Collins CO 80522
970-223-2455
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
Here ❑ Report
Sales tax number is required by all contractors
Are you paying with your trust account?
❑ Yes ❑ No
50255
Is this a residential or c9himercial project? 19Residential ❑ Commercial
If residential, is it: Ed 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 ❑ No Ifyes, you mayneed to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Ifpnor to 1975, you wi/l need an asbestas assessment to submit with this applicadon.
Description of work Remove 20 asphalt squares to decking and replace with20 asphalt squares to
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft 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: John Anderson signature Date