HomeMy WebLinkAbout1712 Lakeshore Dr - Applications/Reroof - 11/19/2014From Affordable Roofing Inc 1.970.207.0289 Fri Oct 24 13:59:11 2014 MST Page 2 of 2
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Planning, Development &Transportation
281 N. College Ave P.O. Box S8D
Fort Collins, CO 80524
Phone 976-416-2740 Fax 224-6134
OVER -THEE -COUNTER PERM]' ONLY
This application is to be used to apply forthe following permits only (check all that apply). ❑ Air Coriditioning
0 Demolition (interior non-structural) ❑ Electrical Altwellon (not service change) ❑ Gas Lighter ❑ Gas Log
11 Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Venbletion ❑ Water Heater ❑ Water Line ❑ WoodlPellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # 13I g I I q I R Date—[ Li
For ofrlre use only
Job site Address (required) Value of construction Qabor; materials, profit)
2 LaKeShaY'e 'Dr 290"K100 $2,g0C)
Property Owner Name Address CWt Late Zip Phone
�k h CAfCkM RC1121112 YaCA Cnll•"S,rn- -
Applicant Name Address City/state Zip Phone q-7U
�' 1� lzn al (w Tr;11x iZCA — 20-7-000
Contractor Address /state Zip Phone
Contractor City of Ft Collins Sales Tax
Sales mx numb�ts-regwwby an mntradors Are you paying With :your trust account? gYes ❑No
is this a residential or commercial proied7 W Residentlal 0 Commercial
If residential, is in -) Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: Cl Bank ❑. Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Oftice ❑ Retail
❑ Restaurant Cl Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No Ifyas, you mayneed to cootactHistoric Preseruatloo-
If this is for a demolition permit What year was the building constructed?
Ifprlor to 1975, you will need an asbestas assessment to submit with this.appl ttlon
Description of work 0.r. n f a,' ti e- 5
OW
xtf lawn sprinkler/backilow preventer, must -list licensed plumber. Yf first-time A/C, must list licensed electrician.
Subcontractors: U,stthe mmpanyname orGty offt ezrIns. liceose #
beizician' Plumber mechanical Roofer - rJ __ Other
1 hereby acknowledge that! have..read.this application and state that the above information, is complete and corract. '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:
Print Name: �� 11riTvn+nih45__Signature "'i