HomeMy WebLinkAbout1221 Intrepid Dr - Applications/Reroof - 12/12/2017City of Planning, Development & Transportation
Fram} 281 N. College Ave P O Box 580
6r` Collins1Fort 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 servey change) ❑ Gas Lighter ❑ Gas Log
■ Heating Unit ■ Lawn Sprinkler ■ Mobile Home replacement &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 # �?Q46844% Date IZ • 1Z- 14
For office use only
Sob Site Address (required)
Value of Construction (labor, materials, profit)
1221 Intrepid Dr Fort Collins, CO 80526
$12,750
Property Owner Name Address
City/State Zip
Phone
John Payne 1221 Intrepid Dr
Fort Collins, CO 80526
970-301-3021
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?
N Here ❑ Report
Sales tax number Isrequvedbyall contractors
00134440
Are you paying with your trust account?
❑ Yes 10 No
Is this a residential or commercial project? ® Residential ❑ Commercial
If residential, is it: 6 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 morel ❑ Yes KI No If yes, you may need to contact Heston Preservation
If this is for a demolition permit, what year was the building constructed?
If pnor to 1975, you wr// need an asbestos assessment to submit with this applicabon.
Description of work Re -Roof 30 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: Lrst 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 '� r Date 12/8/17