HomeMy WebLinkAbout509 Duke Ln - Applications/Reroof - 08/22/2011From Affordable Roofing Inc 1.970.207.0289 Tue Aug 23 08:39:23 2011 MST Page 1 of 1
j: planning, Development rift Transportation
city
"„ 1 of 281 N. O*ge Ave P.O. Box 580
irt
� Unns Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
rmtts onl check all that apply). ❑ Air Conditioning
T{nr the toliowinhis application is to be used to apply g Pe y
ot service change) f3 Gas Lighter ❑Gas Log
D Demolition (interior non-structural) O voltaic
Electrical Alteration (n
0 Heating Unit ❑ Lawn Sprinkler 0 Mobile Home replacement ❑ Roofing 0 Sewer e ❑ Photo
i7 Ventilation 0 Water Heater ❑ Water Line 0 Wood/Line
Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Compute all aApiicable information on the application. IncomDtete appi'rcations will not be accepted.
Application Dabe
ForoRice use only
Value of Cwnstructlon (labor, materiais, profit)
Job Site Address (requ#90
k Address City/State Zip Phone
Property Owner Name
a/Yl D 4�
Address City/State p Phone
;Applicant Name'
TAD /te Zip Phone
:Contractor Address
I es here or try report' ere 0 Report
Are you paying
Contractor icy of R. Collins Sal # Are you paying with your trust account? es ❑ No
.�res�+rnea»ber,sreoW�bygarnnvat�s .
Is this a residential or commerdal project.'? residential � Comroerciai I] Duplex
`3f residential, is it: �c Family petafied O Garage
(single family attad14
rJ Multifamily (apartment)
if commercial, is it ❑ Restaurant 0 Bar ❑ OchChurche13 HOB/M ❑ Medical off+oe []Office ❑Ran
Is this building 50 years of age or more? O Yes if Yes, You
may need to contact t#stxk Preservaifon
Tf this Is for a demolition permM what year was a b"Llc ng constructed?
i fprforto 197T, you w!!! need an asbesM assessment to submit with this appticatron.
of work
lawn sprinWerJbad(flow preventer, must list b plumber. If first-time A/C, mast list licensed electrician.
trcvtttrattors: Lot Me company name or CRY of FrCOUlns ffmr+se 4� Other
« A.ft plumber Medranlcal� Roofer
M
I hereby admowledge that I have read this application and state that tl� above information is oompre>e ano w� �w . om,� �-
comply with all requirements contained herein and city ordinances an$ state laws regulating building eonsbvction. I know tl+at a
;.permit is not valid until it has been pall and Lssued.
Applicant. - ` 1 Date'.
Signature
,:Print Name: V �''��� � i1 .t °� I" S 1 1
x t