HomeMy WebLinkAbout4380 ZIEGLER RD - APPLICATIONS - 10/10/2013Fort Collins
of
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
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 ❑ 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 # Mo '��6 Date
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
4380 Zeigler Rd. 80525
$522,1 17.00
Property Owner Name Address
City/State ZipPt�n�
Avago Technologies 4380 Zeigler Rd.
Fort Collins, CO 80525—
Applicant Name Address
City/State Zip
Phone
Superior Roofing, Inc. 14700 E. 39th Ave
Aurora, CO 80011
303.375.0300
Contractor Address
City/State Zip
Phone
Superior Roofing, Inc. 14700 E. 39th Ave
Aurora, CO . 80011
303.375.0300
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here AReport
lies tax eri reyredb a/lcQntractors
^,
Are you paying with your trust account?
El Yes ❑ No
- T (J
Is this a residential or commercial project? ❑ Residential M 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 a Office ❑ Retail
❑ Restaurant ❑ Other(explai )
Is this building 50 years of age or more? ❑ Yes No Ifyes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was th uilding constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work Tear off existing roof. Install 2 layers of 2.5" insulation, crickets as necessary, and 60 mil
TPO roof system — ()
*If lawn sprinkler/bad flow 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 #
Electrician 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: I dkn4u,
Print Name: ` Signature _ Date G