HomeMy WebLinkAbout2406 Ute Ct - Applications/Reroof - 10/03/201410-03-'14 14:24 FROM -Premier Roofing 9704848308
T-236 P0004/0005 F-473
Planning, Davetcpment&Transportation
`rt�all�n5 281 N. College Ave P.O. Box 580
Fort Collins, LO $0524
Phone 970.416-2740 Fax 224-6134
OVERmTH&WILINTERPERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). 0 Air Conditioning
0 Demolition (Interior non-structural) 0 Electrical Alteration (not service change) l7 Gas lighter 0 Gas Log
d Heating Unit 0 Lawn Sprinkler D Mobile Home replacement 0 Roofing 11 Sewer Line 0 Photo-voltalo
13 Ventilation 0 Water Heater 0 Water Line 0 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 * B14ne1'1 ct 7 Date
xvradfca us�eanly
Job Site Address (regaW Value of conlRrutton (labor, materials, profit)
Property Owner Name Address taty/State ZIP Phone
Applicant Name Address City/state Zip `4 . Phone
Contractor Address city/State Zip Phone
B�Mtv I,C. MLdjVJQ. Sul -Ee 8 U3
Contractor city of Ft. CoYm Sales Tax # Are you paying taxes here or by report? Em*e O Report
S9wamnumberIsregLOWAY8/10 2mm Are you paying with your trusta=unt? 13 Yes E3 No
Is this a residential or rdal project? Sh dartdal 0 Commercial
If residential, is it: L4'Single Family Detached 13 Condo/rewnhome (single family attached) 13 Duplex
O Multifamily (apartment) 17 Garage
It commercial, is it: 0 Bank 0 Bar O Church D Hotel/Mole! 17 Medical office 13 office 13 Retail
13 Restaurant 13 other (explain).
Is this building 50 years of age or more? V Yes o If yes, yrou maynwd1c cnnbctVMnr/cft wwMw
If this is for a demolition permit, what year was the building constructed?
Moor to 197, you W need an aftsW asaararnent toWAIW Wffi th/sSAVAMAbA
of work
*V lawn sprtnkler/backtiow preventer, must list licensed plumber. If first-time A/C, must list llemsed eledkwn.
Subcontractors; I&meconmynameorCWof/f CA& V +y
Elecmdan Plumber. Mechanical Rooter Other
I hereby acknowledge that I have read this application and state that the above infwmadon Is complete and correct I agree to
Comply with all requirements contained herein and city ordinances and state laws regulitt o bulding wnstnrctlon. I know that a
permit is not valid until it has been paid and issued.
Appliaantt (.
Print Name: signature pate 11�.