HomeMy WebLinkAbout4306 STONEY CREEK DR - APPLICATIONS - 9/11/2014City of Planning, Development & Transportation
F _ __t or N. College Ave P.O. Box 580
(�`�'�'-' Collins` i7 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 ® Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer). �1
Complete all applicable information on the application. Incomplete applications will not be accepted. �QJ
Application # �1,� 11� Date
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
4306 Stoney Creek Dr
$7,000.00
Property Owner Name Address
City/State Zip
Phone
Cody Moritz 4306 Stoney Creek Dr, Fort Collins, CO 80525
720-205-0699
Applicant Name Address
City/State Zip
Phone
Contractor Address
City/State Zip
Phone
A to Z Roofing (R-2283) 4251 S. Natches Ct., Unit K, Englewood, CO 80110
303-781-8185
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here ❑ Report
Sales tax number is required by all contractors.
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or commercial project? ' , esidential ❑ Commercial
If residential, is it: 19rSingle Family Detached ❑ Condo/townhome (single family attached)
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office
❑ Duplex
❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No Ifyes, you mayneed to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Ifprior to 1975, you will need an asbestos assessment to submit with this application.
Description of work
14
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/c, must list licensed electrician.
Subcontractors: List the companyname or Cityofft Collins license #
Electrician Plumber Mechanical Roofer ()wa �y`e 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: .� / g r�
Print Name: c C•E*�z Si nature7�L� Date W