HomeMy WebLinkAbout2030 Constitution Ave - Applications/Reroof - 09/28/2017:_ .
City of Planning, Development, & Transportation Services
Flirt Collins Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main 970 416 2740 Fax 970 224 6134
OVER-THE-COUNTER PERMITS ONLY 1a3.13
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 ® Roofing ❑ Sewer Line 0 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 # b n o w 5 S Date September 28, 2017
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
Laurie Pasricha 2030 Constitution Ave Ft Collins, CO 80526 949-533-2198
Property Owner Name Address City/State Zip Phone
Assurance Contractors, Inc. 4025 Automation Way, Ste B3 Ft Collins, CO 80525 970-797-2502
Applicant Name Address City/State Zip Phone
Assurance Contractors, Inc. 4025 Automation Way, Ste B3 Ft Collins, CO 80525 970-797-2502
Contractor Address City/State Zip Phone
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ® Here ❑ Report
Sales tax number is required by all contractors Are you paying with your trust account? 0 Yes ❑ No
50030
Is this a residential or commercial protect? la Residential ❑ Commercial
If residential, is it: ® 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? ❑ Yes m No If yes, you may need to contact Histonc Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work Tear off roof to decking & Re -roof 20.99 sq 2 stories
*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 #
Electrician Plumber Mechanical Roofer 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: Steve Arends _ DSeptember 28, 2017
Print Name: Signature ate P
Reheon date 2 =17