HomeMy WebLinkAbout727 Roma Valley Dr - Applications/Reroof - 12/15/2014City o{ Planning, Development&Transportation
Y} 281 N. College Ave P.O. Box 580
Fort Collins Fort Collins, CO80524
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
O Demolition (interior non-structural) ❑ Electrical Alteration (Pot service change) ❑ Gas Lighter ❑ Gas Log
❑ Healing Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement KI 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 # e6 IA- 12-1%C.-.* - Date
For office use only
Job Site Address (required)
Value of Construction (lab r, material rorit)
1 mo_ \%aU
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I l(Yvs 0 YaSaS
Property Owner Name 11
o h
AAdd�ress City/State Zip
Phone
Applicant Name
Address
City/State Zip
Phone
Contractor
Address
City/State Zip
Phone
CAPITOL ROOFING INC. 6540 S. COLLEGE
FORT COLLINS 80526
970-223-5600
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
tg� Here ❑ Report
sales tax number isrequired by.all contractors.
Are you paying with your trust account?
❑ Yes RfNo
_C�St�()Q
Is this a residential or commercial project? I -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 f i
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes QNo If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Itprior to 1975, you will need an asbestos assessment to submit with this application.
of
`I! 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 a —Akv; S M(1�4�E L
Electrician Plumber Mechanical Roofer Other
I hereby acknowledge that I have read this application and state that the above information is complete ano correct. I agree to
comply with all recluirements contained herein and city ordinances and state laws regulatinGbuilding construction. I know that a
permit is not valid until It has been paid and issued.
Applicant: Print Name: CAPITOL ROOFING INC Signature -- Date