HomeMy WebLinkAbout2836 Antelope Rd - Applications/Reroof - 12/17/2014Fiof
t 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 Prot service change) ❑ Gas Lighter ❑ Gas Log
.0 Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement lil 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 # 5 114 gag o q Date
For office use only
]ob Site Address (requir`ed) / Value
of Construction (labor, mat�rialss,, ro d)
���J�D r\ 0 zIokv'f, S Co 6 S ( c' O� t, r
Property Owner Name Address City/State Zip Phone
Applicant Name Address City/State Zip Phone
Contractor Address City/State Zip Phone
CAPITOL ROOFING INC. 5540 S, COLLEGE FORT COLLINS _ 80525 970-223-5600 i
Contractor City of Ft. Collins Sales Tax #
Sales tar number is reouired by al/ contracrors
C Xns12n�Q
Are you paying taxes here or by report? �& Here ❑ Report
Are you paying with your trust account? ❑ Yes yMo
is this a residential or commercial project? C'9-Residential ❑ Commercial
if residential, is it: M:Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage i
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 IZNo if yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
1l pnor to 1975, you will need an asbestos assessment to submit with this application.
of work
`If lawn sprinkler/backflow preven[er, must list licensed plumber. if first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City olFt Collins license .a
--A1v�S Mtrl"iel
Electrician Plumber Mechanical • Roofer Other
I hereby acknowledge that I have read this application and state that the above information is complete and correct. 1 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. /? n
Applicant:
Print Name: CAPITOL ROOFING INC Signature
Date V,11-71' CI