HomeMy WebLinkAbout6862 Kaslam Ct - Applications/Reroof - 09/21/2011From Affordable Roofing Inc 1.970.207.0289 Wed Sep 21 09:17:23 2011 MST Page 1 of 1
Planning, Dave[opment & •f"tfsP`Grtdtlon
City, 0�281 N. Cdiege Ave P.O. BOX S8D
p„ _ Fort Collins, CO 80524
i"* 970-416-2740 Fax 22+6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be u®d to apply for the following permits only (Check all that apply). 13 Air CQOWIMOning
Cl Demolition (interior non-structurai) 0 Eiectrical Alteration (not service change) L) Gas Lighter (I Gas Log
L1 Heating Unit O Lawn Sprinkler 0 Mobile Home replacement ❑ Roofing O Sewer tine ❑ Photo-mNac
0 Ventilation ❑ Water Heater O Vrater Line Ll Woodipaiiet Stave (must be EPA certified, ppcvide make, model and
manufacturer).
Complets all a008cable informatiom
n on the apptieatim Incoptete applicationstwig not be accepted.
App� btication # Dare Z t , r
n uctton (Iaba'. Maarriaic" Prcft)
job SQit�e�Address (requirc'9 Value of co
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l1i_iZl��la�+r'trm = L YtuXic
i Property Ow net Name Address City/State 7Jp
Address Gtyfsiate Zip Phone
�pJicant Na31e � "��
�c Ma T Address �ry/state Zip Phone —7
i Are vau paying taxes ere or by repo t7 Eiere ❑ ReportCont.
artor 1 of FL Coffins SZtics Aye you payh� with your mist acoaunt?'" No
S 3wS/&5 es pv nurher is rcQrspetl bV aI ovmacvs
If this a al, isttial of mmmert?al plop'
4esidenbal 0 COmmWA1 o Duplex
' If resideMiaL is n: �n, rartciy Oetadhed ❑ Condoltnwnttome (singtclamily atiant+od)
Muttifatttiiy (apartment) 0 raaraga
- rf commercial, is it 0 Bank ❑ Bar ❑ Chinch ❑ "OleVMotef ❑ Medical office ❑ Office i1 pEtan
0 Remurant 0 Other (eKDfain) — _�--
15 this tKildi ig 50 years of age or Cl )IZM IfYa.W YOU maY neind ro Crn'+md flJ aricPrEServa2;an
it this is for a demolition pemi>~ what yeor vms bu"mg consovcted7 -
µyfar r0.I97.i, yorr mll used an a .is assctmtenttb suirrr(t rAVY dax *P&VWM
work
Plumber. if Brst-dme AJC, mkt tist licensed e�ta'an.
1 `IF tavrn sDdn.derlOarldtow plevetRe % muA 15 f¢ereed D� .
: SubcaptractOrs: Lar no amUMV rnwrn w-'GrY ofR Cobi'rzs Jctmse A' r O�
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that I have read rots application and s to tlut the above infomlation is complete an6 correct. i agree to
t herPbr &dmo,cled9e buildOV rvn5ttoctko. 1 know that a
i{ eomDty w<itn as rQquire�nerfs omiatned herein and dtY ordina,e� and cam Wws rMuUUn9
t peratitis not vatW until it Itas been Paid and t6curd. , ) j
6