HomeMy WebLinkAbout1800 Stover St - Applications/Reroof - 09/12/2011From Affordable Roofing Inc 1.970.207.0289 Mon Sep 12 11:21:00 2011 MST Page 2 of 2
'Cityof
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C-"A �UP
Planning, Development a Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER-THECOUNTER PERMITS ONLY
Thls application is to be used to apply for the following permits only (check all that apply)_ Q Air Conditioning
L7 Demolition (interior nonstructural) ❑ Electrical Alteration (not service change) Q Gas Lighter D Gas Log
PHeating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing O Sewer Line ❑ Photo -voltaic
i7 Ventilation ❑ Water Heater ❑ Water Line O Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer)_
jComplete all applicable information on the application_ Incomplete applications will not be accepted, -
PPiication #1 n (o�, Date
For office use only
lob Site Address(requ
Yalue of Construction (labor, materials, profit)
;;Property Owner Name
Address Ci State Zip Phone CiC3
A" dOO)EL
,Applicant Name
Address City/State Zip Phone
T
LAJ • • 00
Contrartar
Address City/State 4+'&VGbAszip Phone
AnffirrtaoV,4-
W,Tn( w 2j C't) �S�S �D�•
Contractor City of Ft Collins S'9L4 Tax #
Are you paying taxes here or by report?' Here ❑Report
-.SaJestaxnumberesrrgrmedby-V M7h :ws
Are you paying with your trust account? 5;Yes Q No
js this a residential or mercial project? Residential ❑Commercial
If residential, is it: 1 Single Family Detached Cl Condo/bwnhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
if commercial, is it: 0 Bank O ear ❑ Church 13 Hotel/Motel O Medical office ❑ Office Q Retail
❑ Restaurant O Other (explain)
is this building 50 years of age or more? ❑ Yes 'P(No Ifyes. you may need to conamf irtstaw Preservation
If this is for a demolition permit, what year was the building constructed?
Ifpncrto 1975, you will need an asbestos assessment to submit with A6isapp/ication.
*If lawn sprinkler/baddiow prevenber, must list licensed plumber. If first-time A(C, must list licensed electrician.
Subcontractors: Ustthecompany name orCdyofFtCoOinsNtense
Electrician Plumber Medians ai Raofer 85 Other
I hereby admowledge that I have read this application and state that the above information is complete and correct. I agree to
Comply With all requirements contained hirein and city ordinances and state tawi regulating building construction. I know that a
permit is not valid until it has been paid and Issued.
I Applicant: .n —!\' 1
Print Name: k11:`te Sign
( ` 1r1!,'^�� atures, :� I U��L�' t Date �( 1
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