HomeMy WebLinkAbout801 Rumford Ct - Applications/Reroof - 05/22/2013From Affordable Roofing Inc 1.970.207.0289 Wed May 29 13:38:15 2013 MST Page 2 of 2
Planning, Dovalopntent & Ttansportation
281 N. College Ave P.O. Box 580
.•. ••' : \..;.\ . �? ' � ' :.. Fort Collins, W BU524
Ptwne g70-416-2790 Fax 2246134
OVER-THE-COUNTER PERM17S ONLY
This application is to be used to apply for the Following permits only (check all that apply). (7 Air,Conditioning
U Demolition (interior rIt n•strur uralj G Electrical Alteration (not service change) O Gas Llghter Q Gas Log
O Heating Unit O l.awn Sprinkler I7 Mobde Homa reptar ement 'KRoo6ng ❑ Sewer Line ❑ Photuwoltaic
G Ventitation G Water Heater 0 Water Line G Wood/Peliet Strive (must be EPA certified, provide make, model and
manurarturer).
Complete all appb ble information on the application. incomplete applications will not be accepted.
Application # IV
For kc us -
Sob Site Addd.r'ess r=uirev',r Value f Construction rtatxx, materials, profit)
f kyvr. jf_d C4_
Property Owner Name• Address CI J/Stag Zip ftme
ct
Applicant Name Address CRy;State 7.ip P axte q'ra -
ia•�{t,ee�tofo-�aoliV%q y.s: A[`t L0--I-r;lh 2c! (-- T-r- r`e? '6s S 3n7-Ira, A
Contractor Address City;/state Zip Phcne
i Contractor City of R. Collins Sates Tax # Are you pay+rig taxes here or by report? O Here G Rp.port
5m� tat nwrbn•ir repc+,rd hyaa'r,xm-.x ..c. Are You pay:ru3 wNh your trust aaount?'`�YEs 0 No
---- —� -- A
!s Uts a rer.iderrfat or romm :rdal project? WResidential Q Cornme.rciel
If residential, is It: ® Single Family Detached ❑ CbnWtownho ne (angle farniy attached) ❑ Duptex
d Mulufarnily (apartment; 0 Garage
If comme, dai, 15 is C1 bank ❑ Bar G Church ❑ HoteUMote? ❑ Medical office ❑ Office G Retaii
❑ Restaurant El Other (explain) '
is Lis bdiding 50 years of age or more, Q yes O No ft pw.S yaw may neid It- cvnwc: %/iz czMe pavon
If tfis is fora demolition permit wlr -L year was We building constructed?
///xx,, to 1975, Iry wr71 need an ashestos aamm n2@ni to submit .•riff: this apprkzfiay.
Description of work
-*if town sprinkk±r/Iwuknr»r ;xeventer, must kst Rcenxd plurntnx. If flm-titne A/C, must :t t IICensLd clectidan.
Subcontraetars,1ra the mnpany ranee :x Gry cf Ft (.i.Ylins Lx»sr: s'
EieaMcian-,• YlmnWr,-,•,•_•--- ------------ `MdiaNral_____—._______— Rrnfv ._k-_1��4_.. Ocher
1 nereby acknowledge that I have read this apphrztion aril static that the stove trAamertipn is r:ompteR: and Qxrect, t ayree to
mmpiy with all requUemtsr!'S tisaainevt llerekrand city ordinances and sia:e laws regulating buiklinq tonstwaiun. t know that a
permit Is not valid until it has been paid and Issued.
Applicant: - �J
Ptint Name:!"� pate
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