HomeMy WebLinkAbout2261 Smallwood Dr - Applications/Reroof - 10/03/2014Ici
Fort Collins
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) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement fl 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 # 61 � u o`i vl T
For office use only
Date 10/3/2014
lob Site Address (required)
Value of Construction (labor, materials, profit)
2261 Smallwood Dr. Fort Collins, CO 80528
$2500.00
Property Owner Name Address
City/State Zip
Phone
Brooklyann Bentley 2261 Smallwood Dr.
Fort Collins, CO 80528
9702326012
Applicant Name Address
City/State Zip
Phone
Zack Stanevich 2614 S. Timberline Rd. #109-182
Fort Collins, CO 80525
9702905393
Contractor Address
City/State Zip
Phone
Select Roofing Contractors, LLC 2614 S. Timberline Rd. #109-182 Fort Collins CO 80526
9709905393
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? W Here
❑ Report
Sales tax number is required by all contractors:
Are you paying with your trust account? Rl Yes
❑ No
Is this a residential or commercial project? Q Residential ❑ Commercial
If residential, is it: ® 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 0 No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work Residential Reroof, as per city codes. 25 Squares
9 stories, using payroll employees
*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 #
Electridan Plumber.
Mechanical Roofer R-2414+ 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: O f2�' C _Y�'FC1t t ✓�
Print Name:1�f1�� V Signature e 49�ate I V
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