HomeMy WebLinkAbout1025 Garfield St - Applications/Reroof - 07/13/2015City Of Planning, Development & Transportation
281 N. College Ave P.O. Box 580
6
Collins C �®p� Fort Collins, CO 80524
`Phone 970-416-2740 Fax 224-6134
OVER -TIDE -COUNTER PERMITS ONLY �10�1Cv eE5.
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 O<oofing ❑ 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 # TI S b53Date 7/ 130 5
For office use only
Job Site Address (required 1
1025 Gar�lelc� �S�
Value of Construction (labpr, materials, profit)
3�,�3000
Prop rty Owner Name Address
Ibud� & VOI) ,1 *0A as}eM 10a5
City State Zip Phone
far eJcj S . FM Co firls, Co S0524 cf70-ig5.71ck,
Applicant Name Address
C'WsI y gnnoi ldl,
City/State Zip Phone
Contractor Address City/State Zip Phone
Roof CheW Inc. 1Wo SKgW0,y Dr k0h(mWCO 90501 303.677923
Contractor City of Ft. Collins Sales Tax #33086
Are you paying taxes here or by report? -KHere ❑ Report
5ales tax number is required by all contractors.
Are you paying with your trust account? ❑ Yes �0
Is this a residential or commercial project? ❑ 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 Eedical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes o Ifyes, you mayneed to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Ifprior to 1975, you will need an asbestos assessment to submit with this application.
Description of work o and I{l) A1. 1 1)"61 ° !aMA1 0 HeY- La& Pr5mIum
Shl ml �s
*If 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 #
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: C l I lJ L I I '� Id __--
Print Name: l�l 1USignatur�
IJ
n'OL Date / 1315
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