HomeMy WebLinkAbout824 Remington St - Applications/Reroof - 08/15/2016Aug 1616 08:10a Westers Roofing, Inc.. 000000000 p.1
Fort of.
Planning, Development & Transportation
2131 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6139
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) 0 Efectrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line D Wood,'Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applicatio s not be accepted.
Application #I 1�� Date �wit 2, I
Far office Use only
Job Site address (required)
14 Re.-
Value of Construction (labor, materials, profit)
,► 5 asv
Property Owner Name
Address
City/State Zip
Phone
9
-212- 913'
Applicant Name � /
n
Address
City/State Zip Phone
DI/IMI Ales�e'cs
8515
S. Ciz
13 quo-oo-tSAS
Contractor
Wts4rs Roon
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Address
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City/State Zip
R-lssr
Phone
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ❑ here
❑ Report
Sales tax numberrsrequired byall cnniractors
Are you paying with your trust account? XYes
❑ NO
Is.this a residential or commercial project? 19 Residential ❑ Commercial
If residential, is it: 195ingle 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? ❑ Yes J9t hlo If yes, you may need to contact Historic Preservation
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
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sue:
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*If lawn sprinkler/backfiow preventer, must list licensed plumber. If first-time A/C, must list licensed electriciam e s 1{
Subcontractors: List the company name or City of Ft Collins Acense # n��
Electrician Plumber Mechanical Roofer i22eotwlz 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: j� t ,� 1
Print Name:-1 0 n I" i- `r7 e S b s Signature
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