HomeMy WebLinkAbout5327 Old Mill Rd - Applications/Reroof - 11/20/2014From Affordable Roofing Inc 1.970.207.0289 Thu Nov 20 16:31:56 2014 MST Page 2 of 2
F&I CoWns
Planning, Development & Transportation
281 N. College Ave P.O. Box 58o
Fort Collins, Co 80s24'
-Phone 970-416-2740 Fax22446134
OVER-` HE-COUN"ITER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply), ❑ Air Conditioning
❑ Demolition (interiornon-structural)O Electrical Alteration.(not service change) ❑ Gas Lighter ❑ Gas Log
El Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line Cl Photo -voltaic
❑ ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (mustbe EPA certified, provide make, model and
manufactures). - . .
Complete all applicable Information an the application. Incomplete applications will not be accepted.
Application # '�1412�_ Date
For o ce use only
Sob Site Address (repuirad). Value f Construd'oh Or, materials, profit)
53 �7 l (I Rel :5 (IM ���b
Property Owner Name Address City/State Zip
,.
Phone
-GaYu
:. .
Applicant Name Address City/State Zip
' a .0
Phone q-7U
t-i W. i;..
ao-7 0
Contractor Address ' /State. Zip
Phone
Contractor City of Ft. Collins Sales Tax
1
5=1es tax m mberisrequiredbyanrontractos Are you.paying.with your trust account? )(Yes
.O No
is this a residential or commercial project? -15R tesidential ❑ Commercial
If residential, Is It -ErSingie Family Detached ❑ Cando/townhome (single family attached) ❑ Duplex
Q Multifamily (apartment) ❑ Garage
If commercial, Is it ❑ Bank ❑ Bar 11 Church ❑ Hotel/Motel O Medical. office ❑ Office ❑ Retail
❑ Resta'urart ❑ Other (explain)
Es this building 9.O years of age or more? 17 Yes ❑ No If yes, you mayneed to conlactHistorlcPiesarvatlon
if this is for a.demolition permit, what year was the building constructed?
If pr1ar to 1975, you will need an asbestosassessment to submit WM this application.
-"
Description of work T3cccY o d r
I)Llfiaitn CUM
£if lawn. spdnMer/bads low preventer, must tilt licensed plumber. If firstAtlme A/c, must list licensed electridan.
`
subcontractors;L/stthe companyname or Oty ora Collins Ncense 0
EIeC•-Idan Plumber _ Merharfcdl Roofer V--IR52 Other
_
1 hereby acknowledge that 1 have read this application and state that:the.above information is complete and correct I agree to tnmpiy with all rEgdrements contained herein and dry ordinances and state laws regulating building construction. I (mow that a
permit is not valid until it has.been paid and issued.
Applicant: f
Pn nt Name: � Tr Signature _,,,, %aiy ( (
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