HomeMy WebLinkAbout812 Queens Ct - Applications/Reroof - 05/22/20153036787615 Roof Check Inc 08:00:00 a.m. 05-26-2015 1 /1
Fort of
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 oofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet St vb a (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # 11) l go F:)2aa
For oSice use only
Date 5/aa/a o 5
Job Site Address (requlro)
la, Queens C
Value of Construction (labor, materials, profit)
58MAA./. oa
Property Owner Na a
VillDili Tu��er
Address
Ala Queens
Gty/State , Zip
a. Cori -Collins co $05a5
Phone
LA) 8oq56�
5 A plicant Name
Ise innond i
Address
City/State Zip
30
Phone
• US 628
Contractor
ROOF MeW Inc.
Address City/State Zip.
WO KqAq Dr Ungmont CD som
Phone
Contractor City of Ft. Collins Sales Tax #�� U 6
salestax number isrequ/redbyall contocrors:
Are you paying taxes here or by report?Here ❑ Report
Are you paying with your trust account ❑ Yes V"No
Is this a residential or commercial project? Residential ❑ Commercial
If residential, is it: Single Family Deta ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, Is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medial office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes Vo If yes, you may need to contact HistoricPreservaton
If this is for a demolition permit, what year was ttfe building constructed?
Ifpnor to 1975, you will need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/backfiow preventer, must list licensed plumber. If first-time A/C, must list licensed el f acid W f L
Subcontractors: List Me company name or Gty of Ft Collins /icense#
Electrician Plumber Mechanical Roofer 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: Print Name: v � Se Tmond i Signature Date d i5