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Community Development & Neighborhood Services
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281 N. College Ave Fort Collins, CO 80522
01141 F6el k...011*
970.221.676o 970.224.6134 -fax
Building Permit #: B1601218
Issued Full: 03/14/2016
Permit Type: Residential Roofing
Site Address: 410 WAYNE ST
Job Valuation: $600.00 Category: Residential
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i Owner: THOMS SALLY ANN
I i 410 WAYNE ST
i FORT COLLINS, CO 80521 Phone: 970-581-0998
ii
Zoning: Front setback: Rear setback: Right setback: Left setback:
Minor Amend #: Plat File #: ZBA Case #:
Zoning district: NCL - NEIGHBORHOOD CONSERVATION - LOW DENSITY DISTRICT
Legal: Subdivision/PUD:
! Code: Res sq ft: Com sq ft:
# of stories: 1 Occ Group:
Fire Sprklr: Stock plan #:
Contractor: JAVERNICK HOLDINGS CORP DBA ATLAS
ROOFING CO.
506 W. 66th St
Loveland, CO 80538
Subcontractor(s)
Roofing: JAVERNICK HOLDINGS CORP DB
Filing #: Lot #: Block #:
Ind sq ft:
Const Type:
Stock plan options:
Basement sq ft:
License #: R+-2530 Supervisor cert #:
Phone: 970-484-7777
Phone
970-484-7777 .
License Number
R+-2530.
Work Description: Tear off existing shingles to decking and re -roof. with 6 squares of asphalt shingles. Provide required attic
ventilation. Install required ice & water•shield4ristall shingles per manufacturer's high wind specifications. 1 stories. Using own
employees.
I SCHEDULE INSPECTIONS: *** By Phone: 970-221-6769 *** By Web: http://www.fcgov.com/CitizenAccess I
***By Mobile Device: http://www.fcgov.com/CitizenAccess/mobile
Inspections: RF
TOTAL FEES PAID AS OF 03/14/16: $41.25 Payment method: Credit Card
** Fee Detail Displayed on Next Page
As a condition for the issuance of a permit, I hereby declare that I am the owner or owners agent, authorized to perform the proposed work on the property described herein.
I agree to comply with all the requirements contained herein, and City ordinances, and State laws associated with such work. I understand that such permit may be
revoked in the event that issuance was based on incorrect information. This permit shall become null and void if the work authorized by such permit is not commenced,
suspended, abandoned or not inspected within 180 days from the date of such permit.
SignaturfE Gtj Print Name: �� r,� t 0 &.� Date:I J_
Form Revised Oct 2010
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Community Development & Neighborhood Services
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281 N. College Ave Fort Collins, CO 80522
970.221.676o 970.224.6134 -fax
Building Permit #: B1601218
Issued Full: 03/14/2016
Permit Type: Residential Roofing
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Site Address: 410 WAYNE ST
I'
Job Valuation: $600.00 Category: Residential
I
Transactions
Method Check Number Date Paid
Amount Paid
Comments
Credit Card 03/14/2016
$41.25
Pay by Javernick Holdings credit card
Receipt issued: 03/14/2016 Total Paid to Date:
$41.25
Fee Description Account Code
Fee Amount
Amount Paid Date Paid Amount Due
Building Permit Fee Without 1000.422010
$27.75
$27.75 03/14/2016 $0.00
Subs
City Sales/Use Tax 251.122030
$11.55
$11.55 03/14/2016 $0.00
County Sales/Use Tax 100.217030
is
$1.95
$1.95 03/14/2016 $0.00
TOTAL FEES:
$41.25 $0.00
$41.25
TOTAL BALANCE DUE AS OF 03/14/2016: IM00
Fee Amounts are valid for date of this document only. Fees subject to change without notice.