HomeMy WebLinkAbout412 E Mulberry St - Applications/Reroof - 02/05/2019City Of Planning, Development & Transportation
F t or N. College Ave P.O. Box 580
%�,—'�'_' Collins` 1 '.7 Fort 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 service 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 #'b`Q1Pbll a Date
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
412 E Mulberry St.
9012.60
Property Owner Name Address
City/State Zip
Phone
Susan Wingate 412 E Mulberry St.
Ft. Collins, CO 80524
760-994-9990
Applicant Name Address
City/State Zip
Phone
Betzy Sanchez 614 5th Ave
Greeley, CO 80631
970-395-0406
Contractor Address
City/State Zip
Phone
Bob Behrends Roofing, LLC 614 5th Ave
Greeley, CO 80631
970-395-0406
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
IDKHere ❑ Report
sales tax number is required by all contractors
Are you paying with your trust account?
XYes ❑ No
41034
Is this a residential or commercial project? X Residential ❑ Commercial
If residential, is it: ❑ Single Family Detached X 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 VNo 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 Tear off 1 layer and install synthetic felt. Install ice&water shield in valleys & eaves. Install edge metal at
rakes & eaves. Install Duration Storm Estate Gray Class 4 shingles. 20 2/3sq. 1 story
*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-1772 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: Betzy Sanchez Signature
Date 2/4/2019