HomeMy WebLinkAbout1343 Cape Cod Cir - Applications/Reroof - 08/19/2011From Affordable Roofing Inc 1.970.207.0289 Fri Aug 19 09:31:39 2011 MST Page 1 of 1
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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). ❑ Air Conditioning
Q Demolition (interior non-structural) 17 Electrical Alteration (not service change) ❑ Gas Lighter Q Gas Log
l7 Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement O Roofing 0 Sewer Lute ❑ Photo -voltaic
l7 Ventilation ❑ Water Heater ❑ Water Line O WoodlPeliet Stove (must be EPA certified, provide make. model and
manufacturer).
Complete all applicable information on the application. incomplete applications will not be accepted.
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Application # 1 1.n Date D r� �!
rof/ice use only
`]ob Site Address (requlmd) ��
Value of Construction (labor, materials, profit)
oC7
3�I a C,a
?Property Owner Name Address
City/State Zip Phone
;Applicant Name Address
City/State Zip Phone
/ 7
;Contractor U Address
/State Zip Phone
Contractor City of Ft. Collins Sal #
Are you paying here or by report? ❑Report
,Wes tarnumbersrequffwbya#cvnbact rs
Are you paying with your trust account? es d No
:LS this a residential or commercial project? Residential ❑ Commercial
1f residential, is it: gte Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
Multifamily (apartment) ❑ Garage
If commercial, is it ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office Ci Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 5o years of age or more? ❑ Yes 3W Ifyes,. you may need to contact N/stvricPreservatton
If this Is for a demolition permit, what year was the building constructed?
IfpHor to 1975, you will need an asbestos assessment to submll' with bh/s app/icadon.
work
;.*If lawn sprinider/baddlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
sSubcontractors-. Ust the company name or Gry of Pt Collins Scense
>EiecMan Plumber Mechanical Roofer-. "I 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: \ — 11f i; d `
Print Narrr2: 111 li �%IIVl1_itl71c7 Signature Date