HomeMy WebLinkAbout2730 Bluegrass Dr - Applications/Reroof - 04/06/2015From Affordable Roofing Inc 1.970.207.0289 Mon Apr 6 08:34:38 2015 MDT Page 2 of 2
C at Planning, Development &Transportation
�-✓�i���� �� $ (� ,r�, ZSS N. College Ave P.O. Box 58C
s�f �ti s �O®U,lt�u Fort Collins, CC 8os2=
� � Pzono 970-41G-274fi Fax Z24-513�
OVER-`zRHIE-C"OU TE P RMITClaw ®Nub
This application is to be used to apply for the following permits only (check all that apply), Q Air Conditioning
10 Demolition (interior non-structural) ❑ Electrical Alteration (rot service change) 0 Gas Lighter Q Gas Loa
0 Hcaiino Unit Q Lawn Sprinkler 0 Mobile Home replacement Q Roofing ❑ Sewer Line 0 Pho;o-volfai;
U Vantilctior. 10 1 dater Heater Q Water Line 0 Wood/Pellet Stove E. b= must d
manufacturer;, ( A cFrtiXled, provide nake, modal and
Gonlpleie ail applicable information on the application, Incomplete applications will not be accepted.
P.ppficm;on Z I SO22
:wr 067ce use only
' yob �si:e;a�aress (raq�Jredj
.��730_ T3l�e Cerra
! ?rpp-�t-:y Owner Name
W
Applicant Name
Contracmcr
aloe of Construction (labor, materials, prorit)
Address City/SuZte zri> Phone
YYiic�iloc'gh Gf� �11ir��C� S6S g7o-481 ���
Address Citylstate Zip Phone c)
rU
I-1 "T� 1 R — Ratt_ 00; -OU;
Address -ctylstat=
tip Phone
Contractor City ct FL Collins Sales Tax z
__r_> tar rn�•nh8.^ KlcQUti'c!1 !]� iu r'O!4lie'r05.
Are you Paying with your trust account? 9Yes Q NO
s :pis a-s'Oential or commercial Project? - i esidential Q Commercial
it re;iOendal, is it: -R Single Family Detached 0 Condo/torvnhome (single family attached) Q Duplex
❑ Pluliifarniiy (ape tment} Q Garage
i is cammeccta(, is it: ❑ Bank Q Bar ❑ Church Q Horel/Motel C] Medical office Q Coca ❑Retail
Q Restaurant ❑ other (explain)
this building go dears o; age or more? ❑ yes O No If yes, you may need to con,act Hisjuric Presaiv�oon - t;^is is for a demolition permit, what year ryas the building constructed?
it Air to 1975 } ou will ne d an asDesios v xssment fa submit v✓ith this aopli
a oUon.
C-2-5Cflpdion of w4r k
ia.rn sorinkierrcarkliow preventer, must list licensed plumber. If 11 -i( A/L:, must fist licensed e(ec#riria t.
8_,bcontractors; List ,,YrecomaarynameorGryoFFrC01#nshL-erase=
•-r
Plumber
-- lzchan rc( Roofzr �_ M.1_ Other
rcreUy orKnowtecge mat 1 have read this application and slaie that the above information is complete and correct, i agree i0
c,,;1a1y wlth all requirements contained herein and city o dinances and state laws regulating building r_onstruction, _I know that a
pernit is trot valid until It has been paid and issued -
Print Name: 1 Csl \l � ��oZr��_signature