HomeMy WebLinkAbout679 MANSFIELD DR - APPLICATIONS - 10/16/2014Oct 16 14 09:27a Severe Weather Roofing
970-223-3383 PA
FCiof
ort Coi[ins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, 00 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).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # 91 LI I `O 3 *J (7 Date 10/16/14
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
679 Mansfield
2100.00
Property Owner Name Address
City/State Zip
Phone
Gloria Christenson 679 Mansfield
Fort Collins CO 80525
970-225-0329
Applicant Name Address
City/State Zip
Phone
John Anderson PO Box 2207
Fort Collins CO 8052-2
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 R. Collins Sales Tax #
Are you paying taxes here or by report?
lifflere ❑ Report
Salostax number srequiredbyadrontactors
Are you paying with your trust account?
❑ Yes ❑ No
50255
Is this a residential or commercial project? 1tResidential ❑ Commercial
If residential, Is it: C?!�Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commensal, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building So years of age or more? ❑ Yes ❑ No rfyes, you may need to contactH/storrc Preservation
If this is for a demolition permit, what year was the building constructed?
Ifpnor to 1975, you w1i need an asbestos assessment to submit with this applxaiyon.
Description of work Remove 21 asphalt souares to decking and replace with 21 asphalt squares to
code.
*If lawn sprinkler/baddlow, preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List fire company name or oty of Ft Collins license #
Efectrician 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
pennit is not valid until It has been paid and issued. ^
Applicant: / )
Print Name: John Anderson Signature Date 10/16/14