HomeMy WebLinkAbout4130 BEAVER CREEK DR - APPLICATIONS - 9/11/2014Sep.11. 2014 10:13AM Bob Behrends Roofing
No, 2536 P. 1
Planning, Development D Transportation
CRY of 281 N. College Ave P.O. Box 580
�I t COLlms Fort Collins, C0,80524
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 CIF 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.
Application # SB4-0S_ QQ - Date
For office use only
9-11-14
lob Site Address (required)
Value of Cc struction (labor, materials, profit)
.4130 Beaver Creek Dr,
Ft. Collins 475
Property Owner Name
Address City/state Zip
Phone
Scott Lee 106 E. Oak St. Ft. Collins, CO 80524
970-222-7101
Applicant Name
Address City/state Zip
Phone
Stacy Anderson
614 5th Ave. Greeley, CO 80631
970-395-0406
Contractor
Address City/State Zip
Phone
Bob Behrends Roofing
614 5th Ave. Greeley, CO 80631
970-395-0406
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report?
IN Here ❑ Report
Saletq r}trq�berisrequiiedbya!!contractors:
Are you paying with your trust account?
IN Yes 13 No
Is this a residential or commercial project? [$ Residential ❑ Commercial
If residential, is it: ®. Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) A Garage
If commercial, is it: • ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel 0 Medical office. ❑ office ❑ Retail
0 Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No Ifyes, you mayneedto contact HistaricPreservation
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.
of work T.O. All
hield at Eaves a
Install Ice
*If lawn sprinkler/backtlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license#
Electrician Plumber Medlanlcal 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; Stacy Anderson
Print Name: Signature
Date
9-11-14