HomeMy WebLinkAbout400 9th St - Applications/Reroof - 04/12/2013From Affordable Roofing Inc 1.970.207.0289 Thu Apr 11 08:22:07 2013 MST Page 2 of 2
,..,, City 01'
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). Cl Air Conditioning
( :l demolition (interior non-structural) Q Electrical Alteration (not service change) M Gas tighter ❑ Gas tog
O Heating Unit 0 lawn Sprinkler 0 Mobile Home replacement �1 Roofing a Sewer tine 0 Photo -voltaic
R Ventilation 0 Water Heater ❑ Water tine n WOod/Pellet Stove (must be EPA certified, provide matte, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # �� 1p5-�d -
- - Date
fi7r officer use evr/v '-
•----
----------- ----- _.._ _ _ _ - --
`: lob Site Address (rNu/re5e) Value of Construction
(lar, na—ttnals,P profit.)
Ar lL_}
Property _
— —
Owner Name Address City/State Zip Phone q 76
_J—...---t 3 f t t-{ +.rY•N rE'. t. v r' 1^y! O-[?:50?�� 1T �,7 •r.'�k-S-
Appticrtr't Name Address
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Address City/Statelip
" Phone Q 'a -
.-. .-,
blt�: oo# t a.o?-..DDG
Contractor '— •----
Address Zip phone
----------- -------- ------------ _
Contractor City of Ft. Collins Sales Tax x Are you paying lAxes, here or try report? Cl Here 0 Report.
sip1- tax rrumer wrNuizdAi, #/mntracrcYs'- Are you paying with your trust account? ❑ yes 0 No
— ' - ----- — --- .
Is this a rEx.,idcntiat or com!nerrial project? 1� Residential 0 ('orr!marcial - .
If residential, is it: 0 Single Family Detached 0 Condo/townhome (single family atta(:hed) p Duplex
Q Multifamily (apartment) CI Garage
If commercial, is it: 0 Bank D Bar 0 Church 0 Hotel/Motel ❑ Medical office D Dffice ❑ Retail
Q Restaurant O Mier (explain)
is this building So years of age or morel D Ye`•, ❑ No If yes, you may nct,d to mntcrrf N.lstrxic /'1 t'S(YVr?t1P11
E If this is for a demolition permit, what year was the building constructers?
_. -------'---
If prior to 19.75, you Zvi// need an asttestos assessnettt to submit witfi this appl/tafinrz
t--------
Description of work,, .. ' ... r � e x'r r"~-i'n`n r-o"e F
_ _
*If lawn sprinklerlbackflow preventer. mtxA list licensed plumber. If fir%•tirne A/C, must list Ocrnsed eiectndan.
Subcontractors: Liss the company ronmx orOty of& Ci7ffy rs Ilciynsc OF
Electrician .........--- ...— P;iMN'r. .—_ tte:tliantral__.. Ranfer �- ITS
i hereby acknowledge that s have read this application and state that the above information is complete and Correct. I agree to
comply will' all requirements contained herein and city ordinances and state laws regulating building construt-tion. i know that a
permit is not valid until it ttas been paid and issued.
Applicant: tt
Print Name: !� ri� `J F in tti i vt S tit t
—.. . Signature / /