HomeMy WebLinkAbout3256 Green Lake Dr - Applications/Reroof - 10/25/2018e to i
City of Planning, Development, & Transportation Services
/Fort 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 service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement O 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.
Application # i ( qyn_
For office use only
Incomplete applications will not be accepted.
Date »- 2,:5r I �(
Job Site Address (required) Value of Construction (labor, materials, profit)
3256 Green Lake Dr. Fort Collins CO 80524 $7,000.00
Property Owner Name Address City/State Zip Phone
Donnell Paul 3256 Green Lake Dr. Fort Collins/CO 80524 970-988-9060
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? ® Here ❑ Report
Sales tax number& required by allconbaciors. Are you paying with your trust account? ® Yes ❑ No
00134353
Is this a residential or commercial project? 10 Residential ❑ Commercial
If residential, is it: ® 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 ®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 replace shingles on a 2 story home with Owens Coming Duration shingles with a 7:12 & 10:12
pitch with 25 SQ's
*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-3611(+)14018-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: �u606&�
Print Name: Emalee Buchholz Signature Date 10i25rz016
Revision date M2017