HomeMy WebLinkAbout2620 Lodi Ct - Applications/Reroof - 05/16/2019City of Planning, Development, & Transportation Services
FOr't 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 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 informattiijon(on�the
application. incomplete applications 1will not be accepted.
Application # I`_) 1 ` � ✓ ✓lIK Date L� /- I `v
lob Site Address (required) Value of Construction (labor, materials, profit)
2620 Lodi Court, Fort Collins, CO 80526 $13,153.34
Property Owner Name Address City/State Zip Phone
Terry Medearis 2620 Lodi Court, Fort Collins, CO 80526 (720) 663-4326
Applicant Name Address City/State Zip Phone
Robert Roberson 3013 Cavalry Ct. Fort Collins, CO 80526 970-393-3520
Contractor Address City/State Zip Phone
HERO exteriors 3013 Cavalry Ct. Fort Collins, CO 80526 970-393-3595
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ® Here ❑ Report
sales tax number is required by all conbactors Are you paying with your trust account? ❑ Yes ❑ No
R-3691
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 [9No Ifyes, you may need
to mnbctHistoricPreservaUon
If this is for a demolition permit, what year was the building constructed?
Description of work ReRoof of 18.22 Squares using class 4 Atlas StormMaster Shake Shingles
on two story home, HERO exteriors to do the work
*If lawn sprinkler/backnow 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 #
Electridan 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: Robert RobersonA Date
Print Name: Signature
Revision date M2017