HomeMy WebLinkAbout3300 Sam Houston Cir - Applications/Reroof - 01/19/2018City Of Planning, Development & Transportation
Fort Collins Fort Co I nls, CO 80524 Box 580
Phone 970-416-2740 Fax 224-6134 ^I/ lanQ2
OVER-THE-COUNTER PERMITS ONLY l'�- I
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 serves change) ❑ Gas Lighter ❑ Gas Log
■ Heating Unit ■ Lawn Sprinkler ■ Mobile Home replacement ;y0ofing ❑ 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 # a% V bu 44&
For office use only
Date , I ) 9 h V
Job Site Address (required)
Value of Construction (labor, materials, profit)
3300 SamQ Houston Cir Fort Collins, CO 80526
$11,475
Property Owner Name Address
City/State Zip
Phone
Scott Pegg 3300 Sam Houston Cir
Fort Collins, CO 80526
970-226-4523
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 is required by all contractors.
Are you paying with your trust account?
❑ Yes KI No
00134440
Is this a residential or commercial project? IN 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 more? ❑ Yes KI No 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 Re -Roof 27 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 RoofinDther
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 1/19/18