HomeMy WebLinkAbout2212 Gemstone Ct - Applications/Reroof - 11/10/2014From Affordable Roofing Inc 1.970.207.0289 Thu Oct 2 15:01:24 2014 MST Page 2 of 2
Fort Collins
of
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524.
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). ❑ Air Conditioning
❑ bemolition (interior non-structural) ❑ Electrical Alteration (not service change) 0 Gas Lighter ❑ Gas Log
❑ Heating Unit d Lawn Sprinkler ❑ Mobile. Home replacement ❑ Roofing ❑. Sewer Line ❑ Photo -voltaic
❑ Ventilation 'a Water Heater b Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer)_
Complete all applicable Information on the application. Incomplete applications wi unot be accepted.
Application # E2 141 L& 2 4 Date l G L)
For office use only
job Site Address frequfred)
Value of Construction (tabor, materials; profit)
'Roi
Property Owner Name Address
City/State Zip
Phone
Applicant Name Address
City/State Zip
Phone 61-7
XQ r a t-1
Lo. t J. T
au -000
Contractor Address
/State Zip
Phone.
Contractor City of Ft. Collins Sates Tax #
sales tax number&rsqulredby.?/ton&aam
Are you paying with your trust account?
I _Yes ❑ No
Is:this a residential or commerciaf project? RReSidential E3 Commercial
If residential, is it: &.Single. Family Detached ❑ Cando/townhome (single family attached) p. Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: CI Hank O Bar ❑ Church. ❑ Hotel/Motel ❑ Medical office ❑Office ❑ Retail
❑ Restaurant .❑ Other (explain)
Is.this building 50 years of age or more? ElYes ❑ No If yes, you may need to Contact Hlstbrlc Preservation
If this is. for a demolition permit, What year was the building mn.stnKted?
If prior to 2975, you, will need an asbestos assessment to submit with this appllcation-
of work
*If lawn sprinkler/badeFlew preventer, must list licensed plumber. If first-time A/C, must Ust licensed electrician. _Q_x
Subcontractors: List the Company name or Gly of Ft Collffts Ileense 0
Elearidan Plumber Mechanical Roofer UL-1g5q Other.
I. tiereby acknowledge that I have read this application and state that the above information is complete and correct I agree.to
comply with -oil requirements contained herein and city ordinances and state laws regulating buliding const ructlon, I laiow that a
permit is not valid until it has been paid and Issued.
Applicant:
Print Name: Signature