HomeMy WebLinkAbout805 Gallup Rd - Applications/Reroof - 05/22/2019Cityof 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 0 Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicableinformationon the application. Incomplete applications will not be accepted.
Application # -6 1 -! 0�5>C2q Date 05-22-2019
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
805 Gallup Road 80521 $4 . 6— 1 (YOW
Property Owner Name Address City/State Zip Phone
Fort Collins Housing Catalyst 805 Gallup Road Fort Collins CO 80521 970-416-2169
Applicant Name Address City/State Zip Phone
Denali Roofing, LLC 3780 N Garfield Ave, Ste 105 Loveland CO 80538 970-660-4417
Contractor Address City/State Zip Phone
Denali Roofing, LLC 3780 N Garfield Ave Ste 105 Loveland CO 80538 970-660-4417
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? 0 Here ❑ Report
Sales tax number is required byall mntractors Are you paying with your trust account? 12 Yes ❑ No
49209
Is this a residential or commercial project? ® 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 Ifyes, you mayneed to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work Remove and replace 18SQ with IKO Nordic Class 4 shingles with all code requirements
*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 FtCoi/ins license #
Electrician Plumber Mechanical Roofer Denali Roofing, LLC 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: nn ��//// ��/ /I/J
Print Name: Chloe Gallegos Signature C �`L�btu%Y6d�8d Date 05-22-2019
Revislon date 2162017