HomeMy WebLinkAbout512 Albion Way - Applications/Reroof - 08/03/201103/17/2007 10:47 3039342676
CAY, of
F6ftCothns
INTERSTATE ROOFING PAGE 01/01
Planning, Development & Transportation
281 N. College. Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134 /jZ
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to, apply for the following permits only (check all that apply). C3 Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) 0 Gas Lighter 0 Gas Log
Heating Unit ❑ Lawn Sprinkler E3 Mobile Home replacement 0 Roofing O. Sewer Line ❑ Photo -voltaic
Ventilation 0 Water Heater ❑ Water Line 0 Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the a piication. incomplete appUcatlons wili not be accepted.
Application #_ % Date
For ofte use only
Job Site Address ( uire� Value of Construction (labor, materials, profit)
T;-1_- 1 ' $
Propeowner Name Address
Gty/State Zip Phone
Applicant Name Address
aty/Staff z -
Contractor Lic # R4-*/ Address
City/State Zip ff - - Phone
- -
Contrador City of FL CoHIW Sales Tax #
Are you paying taxes'here or by report ❑ Re It
sales tz r monter is rear n d byan caadaCWM
Are you paying with your tn&. account? 0 Yes � 0
Is this a resid"allsr commercial project? -5,1=esldendal 13 Commercial
If residential, is It Singie Family Detached 0 Condo/townhome (single family attached) 0, Duplex
D MuNamily (apartment) ❑ Garage
If commercial, is it: C7 Bank 13 Bar 13 Church 0 Hotel/Motel E3 Medical office ❑ Office ❑ Rail
C3 Restaurant D Other (explain)
Is this building So years of age or more? C Yes 0 Nc if yes, you may need to cortct h► qw& Preservation
Yf this is for a demolition permit, what year was the building constructed?
tf prfor In 1975, you w!d need an asbmameamnt to avbm/t with this application
Description of work V.- s '
*If lawn sprinider/backrlow preventer, must Gst rimnsed plumber. If first-time A/C, must list licensed electrician.
Subcontract m: List the company name or 01y of ft Collins license 0
Brlcian- - - Plumder _. Mechanical 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 requirements mntained 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.
Apllkllnts1L j
Print Name: -J :'i; r 61 i _ signature
Date