HomeMy WebLinkAbout4918 BLUESTEM CT - APPLICATIONS - 9/5/2014Fort Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 5.80
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 )i) Roofing ❑ Sewer Line ❑ Photo -voltaic
O 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 # 0�4t)—J L Date
For nffice use only
Job Site Address (required)
SOSJS value of construction (labor, materials, profit)
$
e-jG lb
1�2 59i.30
Property Owner Name Address
City/State Zip Phone
3�1
Applicant Name Address
City/State Zip Phone
Contractor Address
City/State Zip Phone
CAPITOL ROOFING INC. 6540 S. COLLEGE
FORT COLLINS 80526 970.223-5600
Contractor City of Ft. Collins Sales Tax tt
Are you paying taxes here or by report? 44-Here l7 Report
KNo
Sates tax number is reouired by all contractors.
Are you paying with your trust account? ❑ Yes
nrn GOU
Is this a residential or commercial project? tgAesidential ❑ Commercial
If residential, is it: 45-Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 5o years of age or more? ❑ Yes Z?-No if yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
if prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work iSl�c� b►2 �e S Urty. +�� r
grnrod" S�l`Z ( A sCL ( l of c,•'- + ns C. lc�
if lawn sprinkler/backflow preventer, ust list licensed plumber. If first-time A/C, must list licensed electrician.
subcontractors: List the company name or City of Ft Collins license # A(V S AN(-b� V'VJ
Electncian 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 tintil It has been paid and issued.
Applicant:
Print Name: CAPITOL ROOFING INC Signature
Date
Ir