HomeMy WebLinkAbout6524 SOUTHRIDGE GREENS BLVD - APPLICATIONS - 7/29/2019City of Planning, Development, & Transportation Services
Community Development & Neighborhood Services
Fort Collins 281 North College Avenue
Fort Collins, CO 80524 Main: 970.416.2740 Fax: 970.224.6134
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 x 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 #
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For office use only
Date July 29 2019
Sob Site Address (required) Value of Construction (labor, materials, profit)
6524 Southridge Greens Blvd FORT COLLINS, CO 80525 $ 15000.00
Property Owner Name Address City/State Zip Phone
Mark Caughlan Same 970.481.4120
Applicant Name Address City/State Zip Phone
JOHN WESTERS 8513 S CR 13 FORT COLLINS, CO 80525 (970)690-1845
Contractor Address City/State Zip Phone
WESTERS ROOFING 8513 S CR 13 FORT COLLINS, CO 80525 (970)690-1845
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report sales tax
number is required by all contractors. 40877 Are you paying with your trust account? ❑X Yes ❑ No
Is this a residential or commercial project? X Residential ❑ Commercial
If residential, is it: X 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 50 years of age or more? ❑ Yes X No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work - Remove 31 sq laminate, replace w/ Malarkey Legacy class 4 UL2218 shingles, synthetic
felt, drip edge, ice and water, pipe jacks and vents as necessary, per City of Fort Collins code. 2 story
*If lawn sprinkler/backflow 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 # ALVAREZ ROOFING Electrician
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 until it has been paid and issued.
Applicant: JOHN M WESTERS, Western Roofing, Inc. Signature rq"IcDate July 29 2019
Revision date 216/2017