HomeMy WebLinkAbout1436 Last Oak Ct - Applications/Reroof - 11/28/2012From Affordable Roofing Inc 1.970.207.0289 Tue Nov 27 16:06:18 2012 MST Page 2 of 2
c Cityof`" 1 P&1 D 81 N Planning, Development
Avep P.O. BoxTransportation
.! Or l� Collins 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). ❑ Air Conditioning
O 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 ontheapplication. Incomplete applications will not be accepted.
Application # [i V ' Date I I
For of ke use only
Sob Site Address (requlred)
Value of Construction (labor, materials, profit)
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Property Owner Name Address
City/State Zip
Phone '7o
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Applicant Name Address
city/State Zip
Phone 9-70
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Contractor Address
City/State Zip
Phone
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Contractor City of R. Collins Sales Tax #
Are you paying taxes here or tyy report?
❑ Here ❑ Report
Soling aw number cs requried by a# cw,tractom
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or commercial project? 1 Residential ❑ Commercial
If residential, is it: ! 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 ❑ No If yes, you may nem d to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Ifpnor to.1975, ym will need an asbestos assesmnent to submit with this applJcadon.
of work
Uy
*If lawn sprinkler/baddlow preventer, must list licensed plumber. If first-time AJC, must listlicensed electrician.
Suboontrractors: List the company name or aiY offrCoffin /kemw ?
Electidan Plumber Mechanical Roofer Other
I hereby acknowk 9ge 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 aN state laws regulating building construction. I know that a
permit is not valid until It has been paid and issued.
Applicant: �, I
Print Name: lIL(_ �G1 .t .11 fl" SlgrlaWre�� l< < Dabs // �2 7 r//7-