HomeMy WebLinkAbout321 Plowman Ct - Applications/Reroof - 04/09/201504-09-'15 16:20 FROM -Premier Roofing
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Flirt Coilins
9704848308 T-315 P0002/0005 F-611
Planning, Development 8t Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 22+6134
OVER-THE-COUNTER PERMITS ONLY
This application Is to be used to apply for the following permits only (chock all that apply). •❑ Air Conditioning
❑ Demolition (interior non-structural) 11 Electrical Alteration (not service change) ❑ Gas Lighter 0 Gas Log
❑ Heating Unit 0 Lawn Sprinkler ❑ Mobile Home replacement Y Roofing [I Sewer Line ❑ Photo -voltaic
❑ Ventilation M Water Heater ❑ Water Line M 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 #_ g i 5 lDa
For oh9ce use only
Date
]ob Site Address (required) Value of Construction (labor, matetfals, profit)
I 0 u� rrlax� �5b CCU
Property Owner Name Address City/State Zip /� Phone
Applicant Name Address city/State Zip Phone
O rn atr M i 110-
Contractor Address City/State Zip II Phone4g6 U
..r ar4vr..=Z1(11 F=_.MIA1NiwArw A
Contractor City of Ft, Collins -Sales Tax #
,wes tax number Is required by all mtractors,
A0e+ou paying taxes here or by report? 'Were ❑ Report
Are you paying with your trust account? ❑ Yes ID No
Is this a residentai or c9mmercial project? 1$Residenual 0 Commercial
If residential, is it: ).Single Family Detached ❑ Condo/townhome (single family attached) 0 Duplex
0 Multifamily (apartment) 0 Garage ^
If commercial, Is it: ❑ Bank ❑ Bar 0 Church 0 Hotel/Motel 0 Medical office 0 Office 0 Retail
0 Restaurant 0 Other (explain)
Is this building 50 years of ago or more? ❑Yes o Ifyas..you mayneed to contact H WricPtwImMon
If this is for a demolition permit, what year was the building constructed?
lfpdOr to 1975, you wi//need an asbesms r7s' wment to submit with thK applicatiofl.
preventer, must list licensed plumber. If first-time A/C, must list licensed electrician,
subcontractors: i1stthe companynameOfG7tyofRal/Insliaense:A'
Electrician. _ Plumber MechanicalRoofer Other
I hereby acknowledge that I have read this application and sate 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.
Applicants r _0q ` I5
Print Name Signature Date
3