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HomeMy WebLinkAbout2025 Lexington Ct - Applications/Reroof - 05/28/2015MAY/29/2015/FRl 12:30 PM Capitol Roofing, Inc FAX No,970-6893249 P.009 City of F6rt 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 El Demolition (interior non-structural) M Electrical Alteration (not service change) C7 Gas Lighter ❑ Gas Log ❑ Heating Unit 0 Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic LI Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EF'A certified, provide make, model and manufacturer). 9 Complete all applicable information on the application. Incomplete applications will not be accepted, 0, fro Application # pbrV �0 t l For office use only Date 45I PI ]ob Site Address (required) e2n),-s Value of Construction (labor, materials, profit) l.utn 1--, (' 1( un Mau, Property Owner Name Mi -C.% 6 6-. Address (S_ "State zip tdvt ll * S bs Phone q3 � Applicant Name Address U City/State Zip Phone Contractorr c 24P41 Address tKC stb City/State Zip S l Phone 5(1266 r( Contractor City of Ft. Collins Safi Sales t" IYM&Md Tax # Are you payl g taxes here or by report? Are trust EKiere 01Report numjW ly all contractom you paying with your account? ❑ Yes .ru No Is this a residential or commercial project? A@esidential ❑ Commercial If residential, Is it: ADIngle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex ❑ Multifamily (apartment) ❑ Garage 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? 17 Yes &ab If yes, you may need to contact Historic Preservation If this is for a demolition permit, what year was the building constructed? Ifpr/or to 1975, you will need an asbestos assessment to submit with this application, of *If lawn sprinkler/backtiow preventer, must list licensed plumber. If first-(Wne A/C, must list licensed electrician. Subcontractors: List the company name or City ofRCollins license * // ,.. Electridarl Plumber Mechanical Roofer l 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. 9 Applicant., Print Name: `a,� t� � Signatur ll.. Date 5