HomeMy WebLinkAbout4313 Mill Creek Ct - Applications/Reroof - 08/09/2013From Affordable Roofing Inc 1.970.207.0289 Fri Aug 9 14:07:56 2013 MST Page 2 of 2
Planning, Development &Transportation
_ i 281 N. College Ave P.O. Box 580
I Fort Collins CO 80524
` Phone 970�416-2740 Fax.224-6134
This application is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) 13 Gas Lighter ❑ Gas Log
• Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement K Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ ater Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application
Application #� �y ` 21, ITS
Far office use only
Incomplete applications will not be accepted.
Date cr
Job Site Address !required
Value f Construction (tabor, materials, profit)
3 t 3 C-�
e d
perty Owner Na Address
I
City/State Zip Phone
a r �e
Applicant Name Address
City/State Zip( Phone R-76 -
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Contractor Address
ity/State Zip Phone
i
Contractor City of Ft. Collins Sales "Fax #
Are you paying taxes here or by report:? ❑ Here ❑ Report
sales tax numbei,isrequired byall co,, stars
Are you paying with your trust account? O Yes Q No
Is this a residential or commercial project? 9 Residential Q Commercial
If. residential, is It: IK Single Family Detached ❑ Condo/townhome (single family attached) C1 Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ 8ar ❑ Church ElHotel/Motel ❑ Medical office ❑ Office ❑Retail
d Restaurant 0 Other (explain)
Is this building 5o years of age or more? ❑ Yes ❑ No If yes, you mayneed to contact Historic Preservation
if this is for a demolition permit, what year was the -building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work ti� o r r� ��,C i rn-lh q ; ao� rA�`�
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/c, must list licensed electrician_
Subcontractors: Llst the company name or Gty of Ft Collins ifCenSe #.
Electrician.
Plumber Mechanical Roofer R` t y5 9 Other
-
1 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 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.
Applicant: A "
Print Name: j `e)nYt l ltiq S Signature