HomeMy WebLinkAbout1211 City Park Ave - Applications/Reroof - 06/12/2018Fort Collins
of
Planning, Development & Transportation
281 N College Ave P 0 Box 580
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 la 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 # f) I �0 5 a. t� (0 Date Am 2/1 s
For office use only
Job Site Address (required)
Value Of Construction (labor, materials, profit)
1211 City Park Avenue
7,000 00 20 sq
-story
Property Owner Name Address
City/State rp
Phone
CO 80644
970-396-0507
Applicant Name Address
City/State Zip
Phone
Tim Kramp-r 405 22nd St
Greeley, CO 80631
970-396-1389
Contractor Address
City/State Zip
Phone
Indepgndent Roofing Inc Same
970-353-1389
Contractor City of Ft Collins Sales Tax #
Are you paying taxes here or by report?
IR Here ❑ Report
sak?stax number Isrequfiedbyall conlractom
Are you paying with your trust account?
® Yes ❑ No
Is this a residential or commercial project? ® Residential ❑ Commercial
If residential, is it Cl 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 11No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If pnor to 1975, you wdl need an asbestos assessment to submit with this applicabon
Description of work lear off t -0 rJeck, install drip edge, ice g -ard at eaves, 30 lb felt, valley tin, pi
*If lawn spnnkler/backflow preventer, must list licensed plumber If first time A/C, must list licensed electrician
Subcontractors List the company name or City ofFt Collins license 0
Sectrioan Plumber,
Mechanical Roofer R-294 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 Jim Kramer Signature 7vr ),oIr a. , Date ns/1�8_