HomeMy WebLinkAbout4130 SUNSTONE DR - APPLICATIONS - 6/11/2012 (2)Jun 08 12 02:21 p A JJ Shirk Roofing 19706695999 PA
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C�iry. /, p v.e I u v,�( Planning, Development & Transportation
�., 6rt Collins �l0 53 7 281 N. College Ave P.O. Box 580
®-- Fort Collins, CO 80524
Phone 970416-2740 Fax 724-6134
OVER-THE-COUNTER
This appReation is to be used to apply for the following penr
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet St
manufacturer).
Complete all applicable information on the application. Incoi
Application # A-V 314 9
Far office use only
Job Site Address (requite)
-AL-60 �2�/T5�
Property Owner Name Address
Applicant Name / Address
,4 --:s Shirk a oc7't^l"G
MITS ONLY
rely (check all that apply). ❑ Air Conditioning
foe change) ❑ Gas Lighter ❑ Gas Log
Roofing ❑ Sewer Line ❑ Photo -voltaic
must be EPA certified, provide make, model and
applications will not be accepted.
Value of Construction (labor, materials, profit)
�CoSC�C%o"
Gty/State Zip Phone
dma `�=C 31-Y6
Gty/State Zip Phone
/Conntrractor] n � Address wState Zip Phone
ft. J��her� dC C70-YING g�5 e-.1o71ST �I ua �o..� in �2n_S37 /a- e? 9
Contractor City of Ft Collins Sales Tax # - O 3 lD Are you
sales tax numberis mqulred by atlcvnvaan-s. Are you
Is this a residential or commercial project? .PR:ftesidential ❑ 0
If residential, is it: N ngle Family Detached ❑ Condo/townl
13 Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes O No Ifyes,
If this is for a demolition permit; what year was the budding cons
Ifpnor to 1923; you wi/I need an asbestas assessment m submit wi
taxes here or by report? ❑ Here .9 Report
with your trust account? ,Yes' ❑ No
(single family attached) ❑ Duplex
Medical office ❑ Office ❑ Retail
may need to conbct HisBxicPheservabi7n
I L . I'/� I- tl
Description of work TF et r o-%a 4o c4.p c k �iL h S7L4 !/ O.C. P� cu r ct I r-1
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✓ice', r ✓ n vg -e .i q,,j a � k
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*If lawn sprinkler/baddlow preventer, must,dst licensed plumber. If fi
time A/C, must list licensed electrician.
Subcontractors: List the cvmpanynameoratyofaCWllnslicenm
R 681
Elecbidan Plumtrer Medwnical
Roofer K Other
I
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I hereby acknowledge that I have read this application and stawthat the
P�"� information is complete and oared I agree to
comply with all requirements contained herein and city ordinances and sta0e
laws regulating buiding construction. I brow that a
permit is not valid until it has been paid and issued.
Applicant
Prim Name- C rJ. 1�- S}cjntui,.
Date '
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