HomeMy WebLinkAbout708 Dartmouth Trl - Applications/Reroof - 07/20/2015Jul 171508:57a Westers Roofing, Inc.. 000000000 p.1
of Planning, Development & Transportation
Colj 6• 281 N. College Ave P.O. Box 58o
i1 is Fort Collins, CO 80524
�. Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This appli ation is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
❑ Demoliti. n (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating IUnit ❑ Lawn Sprinkler ❑ Nebile Home replacement pARocfing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation. ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Steve (must be EPA cerified, prcvide make, model and
manufacturer).
Complete IL11 applicable information on the application. Incornplete applications will not be accepted.
Applicati in # L7� ���':�� � Date � _
For aTice use only
]ob Site q'ddress
(required)
Value of Construction (labor, materials, profit) a
r . C_pt..t rJs C_o 2c 15
0 55-7+9
Property Owner
Name Address
City/State Zip
Phone
Applicant f�am
Address
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City/State Zip
Phone
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City/State Zip
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Contractor;City of Ft. Collins Sales Tax ;l
Sales tax nu oerisrequireabyairconbadors
Are you paying taxes here or by report?
❑ Here ❑ Report
Are you paying with your trust account?
XYes ❑ No
ND B -
Is this a residential or commercial project? Z Residential ❑ Commercial
If residential, is it: 0Single 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? ❑ Yes X No ff yes, you may need to contact historic Preservation I
If this is for a demolition permit, what year was the building constructed?
lfprior to 1975, you will need an asbestos assessment to submit with this application.
of work
I Y^
*If lawn spi!inkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Sub contractors: Ust the company name o.- City of Ft Collins license # J��`(Z�
Electrician T_ Plumter Mechanical Roofer v C.Olzati Other
I hereby acknowledge that I have read this application and stare that the above information is complete and correct. I agree to
comply witri 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. /7
Applicant:) me�.�I SPrint Na`, X64 signature
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