HomeMy WebLinkAbout5400 Jonathan Ct - Applications/Reroof - 08/18/2015 (2)08-14-'15 13:49 FROM -Premier Roofing
of
Fort Collins
9704848308 T-370 P0002/0003 F-708
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort 90111ins, CO 80524
Pho970-416-2740 Fax 224-6134
OVER-THEaCOUNTER PERMITS ONLY
o:
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 Ooofing C] Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).61 ,
Complete all applicable information on the application. Incomplete applications will not be accepted. 7
Application # � 156 I q i
Foroliloe use only
Date e6- " I e6 (S
Job Site Address (required)
Value of Construction (labor, materials, profit)
Ski CA TOW& M �;
t 5s70
Property Owner Name Address
City/State Zip Phone
(m i4,orn�b h
9'7a— dig r 99�%
Applicant Name Address
City/State Zip Phone
Sbsk 5�tS5
Contractor Address
City/State Zip Phone Y76 - a
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? 19 Here ❑ Report
Sa/es
Are you paying with your trust account? ❑ Yes 11 No
Is this a residential or commercial project? 1W Residential ❑ Commercial
If residential, is it: 0 Single Family Detached 0 Cando/townhome (single famlly attached) ❑ Duplex
Q Multifamily (apartment) M Garage
If commercial, Is it: ❑ Bank 0 Bar ❑ Church 0 Hotel/Motel 13 Medical office la office 0 Retail
13 Restaurant ❑ Other (explain)
Is this building 50 years of age or more? 0 Yes ® No Ifye5, YOumayneeriln cfontactH/sindcPliumvat/on
if this is for a demolition permit, what year was the building constructed?
If prior to 1975, you wi//need an asbesi%is assessment to submit tv/!ii this appllcaffon.
of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If fist -time A/c, must list licensed electrician,
Subcontractors: Ustthe ompanynaMag,-CtyofFtCollins /fcense#
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: SpSk S�+°S
Print Name: 5 Signature�'r _ Date Q
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