HomeMy WebLinkAbout613 S Loomis Ave - Applications/Reroof - 09/17/2018C�305$�
City of Planning, Development, & Transportation Services
Fart Collins 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 se change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler Element RMobile Home replacoofing ❑ 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 # Q,�coD 3 Date
For office use only
9/12/18
Job Site Address (required) Value of Construction (labor, materials, profit)
613 S. Loomis Ave. Ft. Collins, CO. 80521 2,079.95
Property Owner Name Address City/State Zip Phone
Nancy Newman 613 S. Loomis Ave. Ft. Collins, CO. 80521 970-691-4681
Applicant Name Address City/State Zip Phone
Mario A. Munoz IV 7355 Greenridge Rd, Ste. C. Windsor, CO. 80550 970-215-5891
Contractor Address City/State Zip Phone
All Phase Restoration 7355 Greenridge Rd, Ste. C. Windsor, CO. 80550 970-213-1900
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
saiestax number isrequiredbyall mntractom Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or c mmercial project? E�Residential ❑ Commercial
If residential, is it: 49 Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) W06arage
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 9No If yes, you mayneed to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work
RE -ROOF: GAF Armor Shield 2 IR Shakewood Demensional Shingles
5 Squares
*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 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: 6 Mi `� \��NJ
Print Name: ignature Date
Revision date 2/6/2017