HomeMy WebLinkAbout2219 Smallwood Dr - Applications/Reroof - 09/28/2011From Affordable Roofing Inc 1.970.207.0289 Wed Sep 28 12:45:45 2011 MST Page 2 of 2
C(tyof Planning, Development& Transportation
r 281 N. College Ave P.O. Box 580
t:IRe 7� Fort Collins, CO 80524
Phone 97i)-416-2744 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). 0 Air Conditioning
❑ Demolition (interior non-structural) O Electrical Alteration (not service change) O Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler Q Mobile Home replacement Q Roofing O Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application.
Application # 61105690,z
For office use on/y
incomplete applications will not be accepted.
Date r U� l o 5. `1.4 �(
tl tt Site Address (�equirrd) �
Dy
Value Construction (labor, materials, profit)
ti
'Property qwner Narnq Address
C%/ty/State Zip_
Phone
j%G1
�nt Name Address
City/State ( Zip
Phone
i if en--�
itLu
Co tract r Address
bty/State Zip
Phone
r
:Contractor City of Ft. Collins Sales ax
Are you paying taxes here or by report?>q Here
O Report
Salesraxnumber isfequiredbyall mnbadom
Are you paying with your trust account? Yes
❑ No
Is this a residential or commercial project? Residential ❑Commercial
Af residential, is it mDetached Family ched ❑ CondoPmwnhome (single family attached) 0 Duplex
Multifamily (apartment) 0 Garage
If commercial, is it O Bank 0 Bar O Church ❑ Hotel/Motel ❑ Medical office ❑ Office 0 Retail
O Restaurant ❑ Other(expfarn)
Is this building 50 years of age or more? O Yes o Ifyes, you may need to contact Histanc Pre'sevanon
`If this is for a demolition permit, what year was1he building constructed?
Ifprfor to 1975, you wiz/ need an asbesttas assessment to submit wfth this application.
Description of work
*If lawn sprinkler/baddiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors. List the company name orC,ty of Ft Collins license a'
Electrician Plumber Mechanical Roofer Other
I hereby admawledge that I have read this application and state that the above information is complete and correct. I agree to
comply with all requirements contained herein and city ordinances an� state laws regulating building construction. I know that a
permit is not valid until it has been paid and issued. ;
1
Applicant:
;'Print NameSignature\ __ ,%� 1i R � i Date