HomeMy WebLinkAbout413 E SWALLOW RD - APPLICATIONS - 12/19/2014City of
Fort Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
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). O Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (rot service change) ❑ Gas Lighter ❑ Gas Log
❑ Healing 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 # 17��1 l�� 0
For offce use only
Date 1��g11q
Job Site Address (required) Value of Construction (labor, materials, profit)
413 4E St,r-are-r o 11 AS 0 F''VS2-5
Property Owner Name Address City/State Zip Phone
To <n rr03-Yz���G .
Applicant Name Address City/State Zip Phone
Contractor Address
CAPITOL ROOFING INC. 6540 S. COLLEGE
Contractor City of Ft. Collins Sales Tax #
Sales far numteris reouired by att contractors.
C k_)o-5kQn k�o
City/State Zip Phone
FORT COLLINS 80528 970-223-5600
Are you paying taxes here or by report? �ld Here ❑ Report
Are you paying with your trust account? ❑ Yes Flo
Is this or commercial project? [Residential ❑ Commercial
If residential, is it: ZSingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage i
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes Q/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.
DesSSflp Ion of work v-� 5i 11I .S c aCe h r
v>O r adv
r are,- S SAOt1r S
`If lawn sprinkler/backnow 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 A -Av+S n n T
Electrician Plumber . Mechanical Roofer Other
I hereby acknowledge that 1 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:
Print Name: CAPITOL ROOFING INC Signature ___ Date