HomeMy WebLinkAbout3125 Crockett St - Applications/Reroof - 12/12/2017Fort 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 served change) ❑ Gas Lighter ❑ Gas Log
■ Heating Unit ■ Lawn Sprinkler ■ Mobile Home replacement NAoofing ❑ 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 # 1RI:ih9441 Date
or office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
3125 Crockett St Fort Collins, CO 80526
$6375
Property Owner Name Address
City/State Zip
Phone
Jennifer Dartez 3125 Crockett St
Fort Collins, CO 80526
970-493-0933
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?
PSI Here ❑ Report
Sales tax number is required by all contactors
Are you paying with your trust account?
❑ Yes SI No
00134440
Is this a residential or commercial prolect7 ® Residential ❑ Commercial
If residential, is it: 16 Single Family Detached ❑ Condo/townhome (single family attached)
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office
❑ Duplex
❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes M No Ifyes, you may need to contact Hlstianc preservation
If this is for a demolition permit, what year was the building constructed?
If poor to 1975, you wdl need an asbestos assessment to submit with this application.
Description of work Re -Roof 15 squaresofowens corning oakride shingles. Single layer removal, one 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 Tornado Roofing)ther
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 'k- Date 12/8/17