HomeMy WebLinkAbout6250 Clymer Cir - Applications/Reroof - 07/16/2019City of Planning, Development, & Transportation Services
Flirt 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 applicable information on the application. Incomplete applications will not be accepted.
Application # ?) ( el -'� 3,1 ( Date 7/16/19
For office use only
Sob Site Address (required) Value of Construction (labor, materials, profit)
6250 Clymer Circle, Fort Collins CO 80528 $7,200
Property Owner Name Address City/State Zip Phone
Reagan Russell 6250 Clymer Circle Fort Collins / CO 80528 (970) 988-6921
Applicant Name Address City/State Zip Phone
eramiah Larsen 8543 S County Rd 13 Fort Collins, CO 80525 970-669-1020
Contractor Address City/State Zip Phone
Anchor Roofing 8543 S County Rd 13 Fort Collins, CO 80626 970.666.0321
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? 0 Here ❑ Report
Sales tax number is required by allcont2ctors Are you paying with your trust account? 0 Yes ❑ No
R-2446
Is this a residential or commercial project? 0 Residential ❑ Commercial
If residential, is it: 0 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 IZ No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work Reroof; Install 30 sq of Owens Corning CLASS 4 Shingles; 2 story
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the companyname or City of Ft Collins license #
Electrician Plumber Mechanical Roofer R-2446 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:Jeramiah Larsen Signature Date 7/16/2019
Revision date 2162017