HomeMy WebLinkAbout420 Apple Blossom Ln - Applications/Reroof - 08/13/2014No,7491 P
Aue•13. 2014 10:59AM ADVANCED ROOFING
of
Fort Gottins .
Planning, Development & Transportation
281 N. College Ave P.C. Box 580
Fort Collins, Co 80524
Pii ohe Q70-415-2740 Pax 224-E13.4
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits• only (check ail that apply), Q Air Conditioning
❑ Demolition (interior .non-structural) O Ss&VicJ Arsrat(on (not serveice change) C Gas L hGas Loa
ie, �
D heating Unit L2wn Sprinkler^Mobile hone rspiecsme;,t mooting O Sewer amine _ Photo -voltaic
Ventilation G Water Heater ri Water Line: yNood/Pshet Stove (must be EPA Certtfied, provide ,,.aka; model and
manufacturer).
Comp(eta all applicable information on the application. Iricornpiete appl(ca!ions will not os accepted'
ApDIICaCiGn Y L- QSG
For office use Only
3eb Site .4dtrress ,•'requlled)
Property owner Nam � � Adcress
�LYV Ari�GEL� FRODF fUCa Address
7 CG}1-t`�nl nr �S ``I �a✓o �F
Cant-acor Uc # Address
Q—
Contractor City of �t. Collins Safes Tax w-
Sall lax number u reauirad byaw cvrtrac*�rs
altos
Vaipe of Construction naior aterels, prcft)
Ct0 to Coks zip QC>S'�� Phone C1 7 CJ
Cty/State up
C)ty/St2+,e 21p
L :�/ ^,.,/ci
Phone
� q,-70
tdn-1]-�((2
Phone
Are you paying taxes here or by report? - Here C Repo
Are you paying with your trust account? 7 yes ❑ No
Ts thls a esident)ai or commerdal project? Residential
"If residential; i ❑ Commerdai
s (t: )-Singie•;camity Detached•' ' Q Con'db/townfi&hd'(sili�f2 farni!y atrzibed) O Duplex
❑ Multiti roily (apartment) ❑ Garage
If commer lai, is it: p Bank 0 Bar ❑ Church ❑ HOCeVMotel ❑ Medical oR;ca ❑• office ❑ Retail
❑ Aes�aQrant O Gtler (explain)
is tills; building 5o years of age or more? ❑ Yes c7 No if yes, you may nee-,f'ho conz,2ct Mlst-,nc ?reser✓^
If this is for a demolltfoi-T perrnit, what year was the building cons^u ucted?
If poor to 1975, you will need an asbes6tLs- assessl iwnt to submit with tnis app(Icab'cn.
Description of
*If fawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed elec'xician,
Subenntractors: List Me company name Or cry OrR collft license a X51 awn n
Electrtdan Plumber. Me:'uNcai��^
Other
a FICICUynaVe reed this application and state that tliie above lnforTatfon is cornp(Ete and Corr e, I agree tD
corhPtY w(th,all requirements ccnt;alned here(n and city ordinarces and stet= laws regulating building consiru
Permit is not valid until it has been paid and Issued, �on• I know that a
Applicant: -� ..�j
Print Name: ' 1 ' �1~� Slgnaturer
Data