HomeMy WebLinkAbout135 Fairway Ln - Applications/Reroof - 10/06/2015Oct061501:17p FM Roofing Inc.
1-970-221-8526 p.1
FCityof
lirt Collins;
Planning, Development&Transportation
281 N. College Ave P.O. Box 560
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER-THE-00UNTER PERMITS ONLY
This application Is to be used 63 apply for the following permits only (check all that apply). ❑ Air Conditioning
❑ Demolition (interior non-structural) M Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating knit ❑ Lawn Sprinkler ❑ Mobile Home replacement WRoofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line C] 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 #
Cal SO-140(p
For offm rase only
Date /0 —� — t 6—
Sob Site Address ftWimd)
Value of Construction (labor, materials, profit)
S
F70� tQ.—
Property Owner Name
Address
City/State Zip
Phone
'S-ohh
IS',' A-edV�.�C'lc
soles-
97a' JJ-T-�a5
Applicant Name
Address
City/State Zip
Phone
Contractor
Address
City/State Zip
Phone
F M Roo k4 M2 ,
l b �-9 S. Z•Q.
£U-"Qr
9-70- --4.4A �
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
M Here ❑ Report
sales Mxnombfftsreyurred6yallmrrraoxvs
I RS 9 IV
_
Are you paying with your bust a000unt?
❑ Yes >2�No
-- - - -- - -- - - -- - - - -- -
Is this a residentiai or commercial project? K Residential ❑ Commercial
If residential, is it M Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
Multifamily (apartment) ❑ Garage
If commercial, sit ❑ Bank ❑ Bar O Church ❑ Hotel/Motel 0 Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? CI Yes ❑ No If yes, you mayneed to conlactHWdri"cAwmrvebon
If this is for a demolition permit, what year was the building constructed?
Ifp1wto 1975, you WH/need an asbestas assesmemo 5u mrt widr thcs app/itabon.
Desaiption of work
S
*If lawn sprinkW/bacldlow preventer, must list licensed plumber. If first-time A/C, waist list licensed Mectridan.
Subeontraetorsa Let &a company iwme or Cty offt Coffinsfims'se #
Etec ian Plumbs Medianial hoofer
I hereby acknowledge that I have read this application and state that the above infomtatlon is complete and correct I agree to
comply with all requirements contained herein and dry ordinances and state laws regulating building construction. I know that a
penult is not valid until it has been paid and issued.
Applicant:
Print Name: SignatureSU9—Date