HomeMy WebLinkAbout912 MARBLE DR - APPLICATIONS - 7/14/201407/14/2014 09:01 9703539774 INDEPEDENT ROOFING I PAGE 01
City o f Planning, Development Ilk Transportation
r
281 N. College Ave P.O. Box 580 t G�,tins Fort Collins, CO SOS24
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 IN Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater 13 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 # qV ��--1' -�—` Date July 14, 2014
For office use a►h' —
]ob Site Address (required)
Value of Construction (labor, materials, profit)
912 Marble Dr.
6000.00
Properly Owner Name
Address
City/State
Zlp
Phone
Jon Estabrook
912 Marble Dr.
Ft. Collins CO
80526
970-566-9642
Applicant Name
Address
City/State
Zip
Phone
Tim Kramer
405 22nd Street
Greeley, CO
80631
970-396-1389
Contractor
Address
City/State
Zip
Phone
Inds ndent Roofing. -Inc.
Same
970-353-138
Contractor City of R. Collins Sales Tax #
Saps tox numberis rw%~byali mnftam
Are you paying taxes here or by report? LXHere ❑ Report
Are you paying with your trust account? )t:] Yes ❑ No
Is this a residential or commercial project? IN Residential ❑ Commercial
If residential, is it: C$ 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 If yes, you may need tb contact Historic PreAervadon
If this Is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbesins assessment to submit with th/s ap#lltation.
Description of work
*If lawn sprinlder/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors, Ust die company name or cty of Pt Collins Ikens:r #
i:fm"lin Plumber. Mechanical woofer 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.
Applica to
Print Name: Tim Kramer Signature Dare July 14, 2014