HomeMy WebLinkAbout2157 Bock St - Applications/Reroof - 08/02/2018Aug 02 18 01:54p Severe Weather Roofing 9702233383 p.1
CwCity of Planning, Development, & Transportation Services
-�V�i �+otlins Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 90524 Main: 970.416.2740 Fa)c 970.224.6134 q5,`rr''ff
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OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). ❑ AR Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ` 9:Roofing ❑ 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 # H 1 OO U �>S9 Date
For ofte use only
Job Site Address (required) Value of Construction (labor, materials, profit)
2.154 _�o ,V- 5- - � Collins (0 )4 S I-100 -
Property Owner Name Address Gty/State Zip Phone
SVC
924
Applicant Name Address Gty/State Zip Phone
5zv�r� fir t>7G 3(1"�S.tii ' e Elie la2,0 rt, L� ilIr Cf) gc 25 R -LZ3 -2A
Contractor Address City/State Zip Phone
,S,-uc4r,U.JeaA ter n 3'x��S:iotl� '>r iU F+,ltliirl5 Ct� �CF�2S �,v 2z3-ASS
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? 13:zHere ❑ Report
Saks tax numba-israwkedbya#mntrwtors. Are you paying with your trust account? ❑ Yes QZN0
Is this a residential oryornmercial project? Residential ❑ Commercial
If residential, is it: A Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotellmotel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes WNo If yes, you may need to cvnt3ct Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Descripta of work l t 5 s 106 f5 `l i(tCQ j/J t t'1 S o P
S r r bu 4-0 -f-
*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 #
Sectrildan Plumber Mechanical Roorer +W*&her
I hereby admowledge 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
pemdt is not valid until it has been paid and issued.pc
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Prrint Nanme: C G [�L/V i v ` i i/V Signature �� C��it�t// vDate ' f
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