HomeMy WebLinkAbout155 Boardwalk Dr - Applications/Reroof - 03/28/2017Mar 28 1710:34a Skyline Roofing
3037720743
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FCkyof
ort CottinS
Planning. Development & Transportation
281 N. College Ave P.O. Box SW
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER.THE-0OUNTER PERMrM ONLY
This application is to be used to apply for the following permits only (check a8 that apply). ❑ Air Conditioning
❑ Demolition (interior non-sbuchlraq ❑ Mec rical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler 17 Mobile Home replacement ARoot}ng ❑ Sewer Line ❑ Photo -voltaic
0 Ventbation ❑ Water Heater ❑ Water line 0 WoodiPellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete appUcallons will not be accepted.
Application #.
For offm we or*
Date 3 ~ <3 Y - 0 1 -�-
3ab Site Addtress (repuftd)
Valug of Consbuclbmaterials,n (labor, materials, prciN
Property Owner Name _ Address
fity/Stm Zip
Phone
Rat Jo�3rsnl /iSSC'C�rt•'rc5 U-C, 345' Z, 14crs.: c.r:Mw
Vu
4•.^ - n - P p.r ...rc -iC
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17a-J3l-J3Z3
Applicant Name Address
City/State ap
Phone
E44 S Hl• S l rs:,
5-r�dS 4_cnra � u 1'f't- 3
- +..Y r 2c,0eE1cVc
C u
CbntracOor Address
Coy/State Zip
Phone
Contractor City of Pt:. Collins Sales Tax #
Are you paying taxes here or by report?
)9 Here ❑ Report
-S*sislegr&edbya#mnbacfam
Are you paying with your trust amount?
Yes 17 No
2- L3C7+
Is this a residential or commercial project? ❑ Residential ❑ Commercial
If residential, is it ❑ Single Family Detached ❑ Condo/townhome (single family attached)
❑ Multifamity (apartment) Ll Garage
if commercial, is it la -Sank ❑ Bar O Church 0 Hotel/Motel 13 Medical office Q Office
13 Restaurant E3 Other (explain)
O Duplex
❑ Retail
Is this twildktg 50 years of aye or more? Q Yes )&No If yhes. you mayneed In cagt&tH,isfi Presawt n
N this Is for a demolition perndt, what year was the building constructed?
Ifpdbr to 1975, ycv wiN need an asbestas assessrnarlt to submit with bps appflcoWA
Description of work
Wag
rk PP-r- d,:ry 1'n4o. Dca.r U + (00 -+ 'I Crum !-PJW.S'Yr.b�jt- bwiicit rjo
*If lawn sprinkler/baddiow pmrenter, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors; LW b'ie compaVnww or City of Pr e 29W hiow w 0
Plumber Medo Ic Woofer
I hereby acknowledge that I have read this application and state that the above Wormation Is complete and am, . I agree to
comply with all requirements contained herein and city ordinances and Stitt taws regulating buikling mnsLnrdion. I know that a
permit is not valid until it has been paid and issued.
Applicant. n
Print Name: SrE-.1t i3Q-Copc abrre s�17� pace 3 ZS -3c i