HomeMy WebLinkAbout1106 Oakmont Ct - Applications/Reroof - 11/24/2014From Affordable Roofing Inc 1.970.207.0289 Fri Oct 24 13:44:51 2014'MST Page 2 of 2
of planning, Development & Transportation
Fort Colons 281 N. College Ave P.O. Sox 580
'� - Fort Collins, Co 80524
Phone 970-416-2740 Fax 224-6134
COUNIER PERMITS -Ulm....
IV
This application is to be used to apply for the following permits only (check all that apply), ❑ Air Conditioning
17em6liiion (interior non-structural) ❑' Electrical Alteration (not seniioe change) ❑ Gas Lighter ❑ Gas Log
0 Keating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ SeWer Line 0 Photo -voltaic
Ventilation ❑ Wester Heater ❑Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete ail applicable information on the application. incomplete applications will not be. accepted.
Application # B i t4jzo 9C0 Date
Fur orsce Use only `
Job Site. Address (required)
�06 00,K oni- �
Value of Construction (labor, materials, profit)
15? Os.I t\
2,8
Property owner Name Address
City/State
Zip.
Phone
erCk olr
TVQ Ftio
Jr�
Applicant Name Address
City/State
Zip
Rhone q-7U
Contractor
Address
/State
Zip
Phone
Contractor City of Ft, Collins Sales Tax
Sales tar number is recurred by anrnnrrad rs.
Are you paying with your trust account? ,2 -yes
❑ No
is this a residential orconimenial project? ,RResidentfal Cl Commercial
IF msfdentlaf;. is ft. �Sngle Family Detached ❑ Cpndo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) 0 Gauge
f commerdal, is it: ❑ Bank El Bar ❑ Church ❑ Hotel/Motel O Medical.ofn`ce ❑ Office ❑ Retail
17 Restaurant ❑ Other (explain)
is this building 50 years of age or more? ❑Yes O No If yes, youmayneed to conLacth7storicPreservation
Tf this is For a demolition permit, what: year was the building. constructed?
Ifpncr w 1.975, You will need an asbestos assessment to submit m h this al)plicaUon.
"If fawn sprinkfer/backflow:preventar,.musi list ifcensed plumber. If .first-time A/.C, must listlicensed electrician.
Subcontractors: ListthecampanynameorGtyofFrCoJ/inrllcense r
Ele:sician Plumber Mechanical
Raofer_Z:�--�_ Other
I hereby acknovrledge that I have read this application and 'state that the above information Is complete and correct, I agree to , r6inply vwith all requtrements contained hereln and city ordinances and state laws regulating building constructfon. i. know.that.a
Permit. is not valid until it has been paid and Issued.
Applicant.
Print name: 1rny t+nv.i1sAS signature � uaSe C42?, !�} _