HomeMy WebLinkAbout3036 Rustic Ct - Applications/Reroof - 10/23/2017City of Planning, Development & Transportation
281 N. College Ave P.O. Box 580
j F6rt,# Collins 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 served change) ❑ Gas Lighter ❑ Gas Log
■ Heating Unit ■ Lawn Sprinkler ■ Mobile Home replacement 54ofing ❑ 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 # 8ri-D �Q�up-
For office use only
Date 1 O I a 3 11-1
Job Site Address (required)
Value of Construction (labor, materials, profit)
3036 Rustic Ct Fort Collins, CO 80526
$11,050
Property Owner Name
Address City/State Zip
Phone
Chris Brown 3036 Rustic Ct Fort Collins, CO 80526
970-567-7834
Applicant Name
Address City/State Zip
Phone
Alex Krumrai
1600 Specht Pt Rd ST 101 Fort Collins, CO 80525
(970) 224-4042
Contractor
Address City/State Zip
Phone
American Dream Home Improvement
3040 S Finley Rd, Ste #200 Downers Grove, IL 60515
877-266-8666
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report?
In Here ❑ Report
5alestax number isrequired byall contractors.
Are you paying with your trust account?
❑ Yes KI No
00134440
Is this a residential or commercial project? ® Residential ❑ Commercial
If residential, is it: I) 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 KI No If yes, you may need to contactHistoric 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 Re -Roof 26 squaresofowens corning oakride shingles. Single layer removal, two story,
single family dwelling. Check main structure
*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 ANM Roofing 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: Alex Krumrai
Print Name: Signature '� Date 10/17/17