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HomeMy WebLinkAbout5400 Jonathan Ct - Applications/Reroof - 08/18/201508-14-'15 13:50 FROM -Premier Roofing of Fort Collins 9704848308 T-370 P0003/0003 F-708 Planning, Development Bc Transportation 281 N. College Ave P.O. Box 580 Fort�ilins, 00 80524 Pho a 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). El Air Conditioning ❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) [3 Gas Lighter © Gas Log © Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement h? Roofing 0 Sewer Line ❑ Photo -voltaic ❑ Ventilation a 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 # 131 SG `(5 FaroA7ce use only Date �— (5 Job Site Address (requ/red) Value of Construction (labor, materials, profit) P! 60 TOY CACA40n C�, A Property Owner Name Address City/state Zip Phone G Tiapdon C/ 70-218_ qZy Applicant Name Address City/State Zip Phone `Y06 L.. S�IeSS Contractor Address 8rzw1qr Roofin City/State Zip Phone ? 7o - :mol F. K"11m,su��e BF Fvr - (011;1.5 co 805-z Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here E3 Report "as tax number Is required by allcm0actors Are you paying with your trust account? ❑ Yes ❑ No Is this a residential or commercial project? EfResidential ❑ Commercial If residential, is it: 13 single Family Detached ❑ Condo/townhome (single famity attached) ❑ Duplex O Multifamily (apartment) ❑ Garage If commercial, is it: O Bank ❑ Bar ❑ Church ❑ Hotel/Motel 13 Medical office 0 office ❑ Retail ❑ Restaurant 19 Other (explain) 13 p !_ Is this building 60 years of age or more? 0 Yes -It No Ifyes, you may need to contact HIstarrcF'res&vatlon If this Is for a demolition permit, what year was the building constructed? Ifprlor to.1975, you will need an ssbestar assessment to submit w/hh this application. work *If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, musi list licensed electrician. Subcontractors: Llst the coinpany name or aly of Ft Collins license # Electrician Plumber Mechanlcal Rader 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: C1 Print Name: J SS SignatureAK AR_. -w Date 8 - 0 --15 76 CY