HomeMy WebLinkAbout5232 Corbett Dr - Applications/Reroof - 01/22/2015From Affordable Roofing Inc 1.970.207.0289 Tue Jan 20 15.20:03 2015 MST Page 2 of 2
Planning, Development & transportation
28? N. College Ave a,O, Sox SW
Fort Collins, CO 80-12=
Phone 970- .o-?.740 Fax 22c_0-1-a
OVER I HEwCOUNTEOR PERM,.ITS ®N��
-i Ills application is to be used to apply fOr the following permits only {check all that apply), ❑ Air Ccnditioranc:
r, Demolition (interior non-structural) 0Electrical Alteration (not service change) Q Gas tighter rJ Gas I_ag
if -1es inn unit 0 lawn Sprinkler 1_i Ulabile Nome replacement ❑ i:oofln [7 Sealer tins p t. i,: Q U Photo -voltaic
v ,..n,..1~ilOn l l llu_3r 4eat3r C2 'v,4eier Une '1 wood;Pelle, SiQ�lS {!n;:fii tale EPA Cc:l litisd• r�r0(+Id@ Rl'cYe, nlGdei ;.jnC•
ma nui ecturer?.
Complete all aa[aficable information on the application. Incomplete applications will not be accepted.
Date
I Or Of kl use only
nor Slt:e Address (required) ..'-_•.".,.--_-----•---•.---._...__._
Value f Construction labor, m
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(. arEriais r Z?
nP ry Owner Name Address City,/Ste sip Phone
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Address
city/state Zip
Address
Phone
Cofltractor City of Ft. Coiling Sales Tax
as ;xnumb:riSR'`]Ullci!i1ya.7f.211n7.z✓van; Are you paying with your trust account?
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19 :2-Stdc.n�.IS1 Or gOCiimarClal prOJ�^CY< ,t'1"�L'51d81117e1 0.COn7inercial
.r r2_iuen;:Sl, is it: :a-Singfa rarnay Detached 0 Condo/iv;vnhe!rte (single FaWY attached) Q Duplex
L7 Muld-mmiiy (api;rn r tj 0 Garage
._cmnt2r6al, is it: ❑ Bank 0 Bar 0 Church [.3 hotel/motel lJ Medical orrice ❑ Onf,a 01 Retail
G rcestauranC 0 Other(expiate)'..___-._,,._-- —
s this -Julldlm 5C years o9 age or mare? C? Yes 0 No If yz , yvu ma ,7� ^ r ` ; `— ; -
-:hts i-_ for a demoliifon permte, NJilat year was the building cmnstructed? `d to cnrra t Fr tors. Pr25�rvairpn
to rh?!/ need On
.,----- asbesRlSdCo Sltmil with AtLk: aP—OrA,c;nn.
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Gescdpuon
or
^?'E i aavr• sprin!c(er; hcyglcftoti+ oreventer, must list 11r:ensed plumber, rf fir., —,-lime A/C, mus•:: list licensed etNG.7 t:iar:.
Subcontractors: L:sr.hecompanynanrzorC/y nPFrCoINnsJ6rnsf
......... - •--• Pimlher P18Cil@mCc'.1Roofer.
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herc!3Y ac;cnU:•rl`ciye that d have read this application and state that the above information is comnlete and cnrract. t agree to
^.••- ply :a+iih all repuirernents contained herein and city ordilances and state la.vs regulating building construction, T know that a
;!er:nis fs no - valid until it has been paid and issued.
i
^rfntName:
Signature Aen.
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