HomeMy WebLinkAbout912 MARBLE DR - APPLICATIONS - 11/1/201110/31/2011 21:18 9703539774 INDEPEDENT ROOFING I PAGE 01
�.F6Cityof Planning, Development &Transportation
r` Collin 1^ s 281 N. College Ave P.O. Box SBO
Fort Collins, CID A0524
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
O Demolition (interior non-structural) ❑ Electrical Alteration (not service change) O Gas Lighter Q Gas Log
❑ Heating Unit ❑ Lawn Sprinkler D Mobile Home replacement Roofing p 5ewer Line, ❑ Photovoltaic
❑ Ventilation O Water Heater ❑Water Line ❑ Wood/P. . Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete ap I' t
p rca ions will not be accepted,
Application # I
For oflFce use only 'Date
Job Site Address (requlred) Value of Construction (labor, materials, profrtl
Prope Owner Na a Address
City/State ZiR Phone
b _
Applicant Name Address qv-51o(o_ q
Same City/State Zip Phone
I Contractor Lic,#R294 Address
Independent Roofing Inc. 405 22nd St CityGState
Contractor City of FL Collins Sales Tax #
saes tarnwrnber is required bya//cWpactm
., reeley, CO
Zip Phone
80631 97fi=asa_
Are you paying taxes here or by report? ❑ Here
Are you paying with your trust account? X] yes
Is this a residential or. commercial project? ® Residential ❑ Commercial If residential, Is It CT'Stngle Family Detached ❑ Condo/townhome (single faml
❑ Muftlfamlly (apartrnent) ❑ Garage h' attached) 0 Duplex
If wmmerclal, is iC ❑ Bank 0 gar 4 Church ❑ Hotel/Motel 13 Medical ofrice 0 Office 0 Retail
I7 Restaurant El Other (explain)
Is this building 50 years of age or more? ❑ yes . R(No Iryw,, you may need to ��H/brio PreservaDon
If this is for a demolition permit, what year was the building constructed?
If aiortn Y975, you w/// need an asbestos azMDMntm sabmit wilfi rhis app/rcat/on.
*If lawn sprinkler/barkfiow preventer, ML9 list licensed plumber. If first-time
A/c; must list licensed electrician,
Suticoniraclnrs. List bye company name or C&y of ft Comns rcerwe AF
Sedrician Plumber Medranira Rooter �`1 ��-1
Other
1389
)f7 Report
U No
17 eiruww,cuye mat A nave read this application and state that the above Information is complete and cored I agree to
lomply with all requirements contained herein and city,, ordinances and state laws regulating building constn,cgon. I know that a
permit is not valid until it has been paid and issued.
Applicant:
Print Name ► r,� rayy.%er_ Sgnawm Date Q - i q' 1 A