HomeMy WebLinkAbout2813 Virginia Dale Dr - Applications/Reroof - 09/17/2018�103
City of .Planning,. Development,- & Transportation Services.
t C011l�s 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
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 ID 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 #
For office use only
Date
Job Site Address (required) Value of Construction (labor, materials, profit)
2813 Virginia Dale Drive Fort Collins CO 80521 7,840.76
Property Owner Name Address City/State Zip Phone
Miles Daly 2813 Virginia Dale Drive Fort Collins CO 80521
Applicant Name Address City/State Zip Phone
Rusty Bucket LLC, dba Tico's Roofing PO Box 1326 Fort Collins, CO 80522 970-566-1884
Contractor Address City/State Zip Phone
Jake Herzanek PO Box 1326 Fort Collins, CO 80522 970-566-1884
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? N Here ❑ Report
Sales tax number isrequlredbyall contractors. Are you paying with your trust account? ❑ Yes ❑ No
00134353
Is this a residential or commercial project? ❑ Residential ❑ Commercial
If residential, is it: C4 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 SO years of age or more? ❑ Yes [Z No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work Remove and replae shingles on a 1 story home with Tamko Heritage with 18SQ
*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 R-3641(-)14016-R() 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:
Print Name: Emalee Buchholz Signatu /a a 0911712018
Revision date 2&2017