HomeMy WebLinkAbout5409 Parkway Cir E - Applications/Reroof - 08/04/2011From Affordable Roofing Inc 1.970.207.0289 Thu Aug 4 09:47:36 2011 MST Page 1 of 1
Citycif
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 22+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
LI Demolition (interior non-structural) ❑ Electrical Alteration (not service change) 0 Gas Lighter ❑ Gas Log
O Heating Unit ❑ Lawn Sprinkler O Mobile Home replacement ❑ Roofing ❑ Sewer Line 0 Photo -voltaic
❑ Ventilation 0 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 # 1S 1 f9y Li 5� Date S . " . 2-V
ford tce use only
]ob Site Address (required)
value of Construction (labor, materials, profit)
00
:Property Owner Name I Address
City/State Zip
Phone
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• gosd2
8
'Applicant Name Address
city/State Zip
Phone
h
Co tractorl Address
Co/State Zip
Phone
:Contractor City of Ft. Coffins Sales x
Are you paying taxes here or by report? ere
❑ Report
sakes tax number ismqukedbya#contractors
Are you paying with your trust account?
O No
'Is this a residential or cpiamercial project?Residential ❑Commercial
Tf residential, is it Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
Jf commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other ( lain)
Is this building 50 years of age or mare? O Yes 0 If yes, you may need to contact Historfc Preservation
;If this is for a demolition permit, what year was the building constructed?
1f p6or to 1975, you will need an asbestos assessment to submit w/th this application.
:Descriptio of work
•1
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r
*If lawn spfinid r baddlow preventer, must list licensed plumber. If first-time A/C, must list licensed ele
;Subcontractors: List the company name or CVofftCollins lkense
"Electrician Plumber Mechanical Roofer Other
hereby aclmowledge that I have read this application and state that the above information Is complete and correct. I agree to
.I
immpry with all requirements contained herein and city ordinances ano state laws regulating building construction I know that a
;permit is not valid until it has been paid and issued. s
i t
Applicant; ( — I ".: .+ E
"Print Name: tfkV^" 9 1 ' .; '. `�"2 " Signature's . j u� sl 1 Date