HomeMy WebLinkAbout1308 Lakewood Dr - Applications/Reroof - 05/23/2016F®rt Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 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). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement IX 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 # %'E>i Ld,(Dx-1 Date MAY 23, 2016
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
1308 LAKEWOOD DRIVE
$9 290.00
Property Owner Name
Address City/State Zip
Phone
MERLIN ROBERTS
820 DICKENS CT. LONGMONT, CO 80501
(303) 772-4591
Applicant Name
Address City/State Zip
Phone
TODD TREHEY
6115 BEN PLACE BOULDER, CO 80301
(303) 449-5176
Contractor
Address City/State Zip
Phone
BLACK ROOFING, INC.
6115 BEN PLACE BOULDER, CO 80301
(303) 449-5176
Contractor City of Ft. Collins Sales Tax
# Are you paying taxes here or by report?
I$ Here ❑ Report
Sales tax number is required by all contractors
Are you paying with your trust account?
❑ Yes IX No
R-910
Is this a residential or commercial project? R Residential ❑ Commercial
If residential, is it: M Single 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? R Yes ❑ No If yes, you mayneed to contact Historic Preservation (1959)
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work RE -ROOF WITH OWENS CORNING DURATION SHINGLES - COLOR: TEAK
5/12 PITCH, 21 SQUARES.
*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 #
Mechanical Roofer 1/0 Other
Electrician Plumber.
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: j;1
2�
Print Name: < %G '� Signature Date
0 / (�
4058-16