HomeMy WebLinkAbout1916 W Elizabeth St - Applications/Reroof - 09/09/2011From Affordable Roofing Inc 1.970.207.0289 Fri Sep 9 14:24:16 2011 MST Page 1 of 1
is
City of�
planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 805Z4
Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERWIS ONLY
is application Is to be used to apply for the following permits only (check all that apply). 0 Air Conditioning
Demolition (interior non-structuraQ 0 Electrical Alteration (not service change) O Gas Lighter O Gas Log
Fleeting Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing CI Sewer tine 0 Photo -voltaic
Ventilation ❑ Water Heater 0 Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
-er).
all applicable information on the application. Incomplete applications will not be accepted.
For otfke use arty
Site Address (1equJi00
owner Name
Address
cant Name Address
INffo ► / � I 1 J
ractor City of Ft. Collins S9k9 Tax #
taxnwn&cr & mqul2d by a# mab'adam
Date
Value of Construction (labor, materials, profit)
City/State Zip Phone,,,
City/State Zip Phone
zip Phone
V 525
Are you paying taxes here or by report? Here 1:3 Report
Are you paying with your trust account? Yes 0 No
Is this a residential or cgrnmercial project? T�(Residentlal 11 Commercial O Duplex
If residential, is it mgle Family Detached ❑ Condo/townhome (single farii{y attached}
Muiti%mity (apartment) ❑ Garage
if commercial, is it: D ea* ❑ Bar ❑ Church ❑ Hotel/Motel Medical office Office O Rdait
❑ Restaurant 0 Other (explain) need to contact Hi'stoncA%sanvatlon
Is this building so years of age or more? D Yes �No rf jm?* r'nu may
if this is for a demolition permit, what year was the building constructed?
rpifor to 1975, you will need an asbestos assessment to submit WW lids application.
of work
*If lawn sprinkler/baMOw Preventer, must list licensed plumber. If fat time A/C, must list licensed electrician.
Subcontrac1mrs; List &W CWW"y name or �Y ofFt Collins license
Other
Elecbidan______�---
Plumber Mechanical_ _�--- Roofer—&-
.J hereby aclmowledge that I have read this application and slate that the above information is complete and correct I agree to
comply with all requirements contained herein and city ordinances and state laws regulating building construction. I know that a
permit Is not valid until it has been paid and Issued. { i
Applicant: ! j� }; ; ► Date
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