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HomeMy WebLinkAbout209 Cheops Ct - Applications/Reroof - 08/22/2011From Affordable Roofing Inc 1.970.207.0289 Mon Aug 22 10:18:09 2011 MST Page 1 of 1 City of fl ^ , x:^ 9 a k" ;��,,,,� p7 �. 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). 0 Air Conditioning O Demolition (interior non-structural) Ll Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log Q Heating Unit ❑ Lawn Sprinkler Q Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic P 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 #_8 11 OS-9 Q CO Date �111 Far ofl&e use onty Job Site Address ilregrNred) Value of Construction (labor, materlats, profit) �D ;Property owner Nam Address Gty/Stage Zip Phone x J Id IDo 'Applicant Name Address V City/State Zip Phone v <Contractor Address City/State Zip Phone I7. I'�- 1 .'Contractor City of Ft. Collins Sal # Are you paying t4m here or by report?ere ❑ Report S vstrnwnbersrequuedtrya#waftacitm Are you paying with your trust account? es ❑ No Is this a residential or commercial project? residential ❑ Commercial If residential, is it: gie Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex El Multifamily (apartment) 0 Garage If commercial, is it- 13 Bank 13 Bar 17 Church 0 Hotel/Motel ❑ Medical office O Office O Retail © Restaurant ❑ Other (explain) Is this building SO years of age or more? ❑ Yes Ifyes, you may need to contactHlstoncPreservabbn i If this is for a demolition permit, what year was the building constructed? ifprlor to 1975, you will need an asbestos assessment to submit wltb th[s application_ m *If lawn sprinkler/baddlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician. Subcontractors: UstthecompanynameorCity &ITCoNnsAcense Electrician Plumber Medmanical_ Roofer O[her 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 ana date laws regulating building construction. I know that a permit is not valid until it has been paid and issued. ppl Print Name: j1111:L( �UTA "� �; Signature. ' 1' "v t Date