HomeMy WebLinkAbout600 REPUBLIC DR - APPLICATIONS - 10/7/2011Oct 0511 05:21 p 5 Star Roofing Co.,LLC
970-663-7827 p.1
FCiof
®rt Collins
Planning, Development &,Transportation
281 N. College Ave P.O. Bax 580
Fort Collins, CO 80524 i 1
Phone 970-416-2740 Fax 224-6134
,
OVER-THE-COUNTER PERMITS ONE Y
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 Lig ; ter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement( Roofing ❑Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ WoodlPellet Stove (must be EPA certified; provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will no be accepted.
Application #
11 D Date / w
For odiice use only j
Job Site Address (required)
Value of Construction (lat
materials, profit)
L C
Property Owner Name
Address City/State
Zip
Phone
.I 1--' „-,;•l,i-.i��,o..-rii� Ci'�
i c
C. �.�'. � '� ,'���';1:��_i_
.,
�`�. �
ii
Applicant Name
Address City/State Zip
Phone
J Sftb— c A)4 Qi) L '- PY-) , \nl �4h •S� LovCIcu-1C,
fls btflb-clIIG
Cont-actor J
tra
Address City/State Zip
Phone
5 JIGU r n r L�, --
O �V O�'L'.�QiY� L'l1Y�
�c11%J—DIIC
Contractor Ci f Ft. Collins Sales Tax
# Are you paying taxes here or by rept
irt? ❑ Here gReporit
Sa/es4wnumberisrequired byall mntractom
Are you paying with your trust acco
nt?�9 Yes ❑ No
Is this a residential or cpmmercial project? V'Residential ❑ Commercial I
If residential, is it: )1 Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage I .
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office 13 Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No ifyes, you may need La contact Hi5tork Preservabon
If this is for a demolition permit, what year was the building constructed?
rf prior to 1975, you wi/I need an asbestos assessment to submit wiffi this applica80n:
Description of work
*If lawn sprirdder/backflow preventer, must list licensed plumber. If first-time A/C, must list
Subcontractors: List the company name or City offt Col/ins license #
Electrician Plumber Mechanical Roofer
I hereby acknowledge that I have read this application and state that the above information is
comply with all requirements contained herein and city ordinances and sta laws regulating bl
permit is not valid until it has been paid and issued. 1 \
Applicant: r
PrintName:���GLunc) Signature
Other
and correct. I agree to
struction. I know that a
l G;'5�l ` C,i i