HomeMy WebLinkAbout6603 Autumn Ridge Dr - Applications/Reroof - 11/17/201111/17/2011 02:25 3032384051 INTERSTATE ROOFING PAGE 07/14
Planning, Development & Transportation
y o r 281 N. College Ave P.O. Box 580
Collins Fort Collins, CO 80524
per, Phone 970-416-2740 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). O Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter O Gas Log
❑ Heating Unit ❑ Lawn Sprinkler 0 Mobile Home replacement ❑ 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. Incomplete applications will not be accepted.
Application # V9 I 1 10�11?_Cl _ Date
For office use only
Is this a residential or commercial project? ❑ Residential ❑ Commercial
If residential, is it: ❑ Single Family Detached C5JZondo/townhome (single family attached) D Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it. O Bank ❑ Bar ❑ Church O Hotel/Motel O Medical office O Office O Retail
❑ Restaurant ❑ Other (explain) _ _._.—
Is this building 50 years of age or more? ❑ Yes OQ:�o If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If prior ib 1975, you will need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license #
Electrician - Plumber meChanical Roofer L7Other
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: �rr,,,��� I I
Print Name:�kh _ 4r1 c .Signature �__,_______. Date .,..�� 1 1?J a__