HomeMy WebLinkAbout925 BITTERBRUSH LN - APPLICATIONS - 9/15/2014Sep 03 14 02:58p Severe Weather Roofing
970-223-3383 PA
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 7-24-6134
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 ❑ 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. 4f I „f
Application # 6I409aP2 Date 913120t4" �•I �/
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
925 Bitterbrush St.
1800.00
Property Owner Name Address
City/State Zip
Phone
Steve Dilger 925 Bitterbrush St.
Fort Collins CO 80525
970-420-5813
Applicant Name Address
City/State Zip
Phone
John Anderson PO Box 2207
Fort Collins CO 80522
970-223-2455
Contractor Address
City/State Zip
Phone
Severe Weather Roofing PO Box 2207
Fort Collins CO 80522
970-223-2455
Contractor City of Ft: Collins Sales Tax #
Are you paying taxes here or by report?
14Here ❑ Report
Sales taxnumberisrequtmdbyaliconrractom
Are you paying with your trust account?
❑ .Yes ❑ No
50255
Is this a residential or cDmv(iercial project? V Residential ❑ Commercial
If residential, is it: ❑-6ngle Family Detached ❑ Condo/tawnhome (single family attached) 0 Duplex
❑ Multi€amily (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 to contact Historic Pfeservabon
If this is for a demolition permit, what year was the building constructed?
If pnor to 1975, you will need an asbestos assessment to submit with this application.
Description of work Remove 18 asphalt squares to decking and replace with 18 asphalt squares to
*If lawn sprinkler/badd9ow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or Gty of Ft Collins license 0
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:
Print Name: John Anderson signature Date 9103/2014