HomeMy WebLinkAbout7339 Triangle Dr - Applications/Reroof - 09/15/2011From Affordable Roofing Inc 1.970.207.0289 Thu Sep 15 11:34:55 2011 MST Page 1 of 1.
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Planning, Development & Transportation
281 N. College Ave P.O. Bok 580
Fort Collins, 00 8OS24
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). ❑ Air Conditioning
0 Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
0 Ventilation l3 Water Heater 17 Water Line ❑ Wood/Peflet Stove (must be EPA certified, provide make, model and
manufacturer).
<: Complete all applicable information on the application. Incomplete apptications will not be accepted.
Application #-B l l 07ye8$
For office use only
Date 0. 1 5 - I L
:Job Site Address (required)
Value of Construction (labor, materials, profit)
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(Property Owner Name U
Address
City/State Zip
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':.Contractor City of Ft. Collins Sales
Saiestax numberisrmulmdbyaffcanbaoam
Are you paying taxes here or by report?5 Here
Are you paying with your trust account?Yes
❑Report
❑ No
Is this a residential or commercial project? �KResidential ❑ Commercial
';If residential, is it: V&mgle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
43 Multifamily (apartment) 13 Garage
<If commercial, is it: ❑ Hank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office 13 Office E3 Retail
❑ Restaurant ❑ Other (explain)
Is this building Slt years of age or more? ❑Yes o ifyes; you may need to mnfact l*stodc Preservation
If this is for a demolition permit, what year was4the building constructed?
Ifpnorto 1975, you w/11 need an asbestos amsssmenr to submit with this application.
: *If lawnsprinlder/badiflow prevaenter, must list licensed plumber. If first-time AJC, must list licensed electrician.
rSubcontmctors: List the company name orC ly of ft Colllns Ikense #
IIectrician Plumber Medianiral Roofer Other
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 requirnlnents contained herein and city ordinances an f state laws regulating building construction. I know that a
permit Is not valid until it has been paid and Issued. ;
<Applicallt: f 4,
Print Name- 1 4i `rllli.t' ! SignDate