HomeMy WebLinkAbout428 W OAK ST - APPLICATIONS - 1/3/2013From Affordable Roofing Inc 1.970.207.0289 Thu Jan 3 10:54:31 2013 MST Page 2 of 2
City Planning, Development & Transportation
FtY .y 281 N. College Ave P.O. Box 580
t �,,,,.,ol ns Fort Collins, CC) 80524
- Phone 970-416.2740 Fax 224.6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to appty for the following permits only (chock all that apply). ❑ Air Conditioning
17 Demolition (interior non-structural) D Electrical Alteration (not service change) 0 Gas Lighter 0 Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Boma replacement ❑ Roofing ❑ Sewer Line Ci Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line Cl Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable Information on the application. Incomplete applications will not be accepted.
Application .# & f ` 00 4 a- Date
r-ar atrve aw only
Sob Site Address (required) Value of Construction (tabor, materials, profit)
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Property Owner Name Address City/State Zip A Phone ,yo
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Applicant Name Address Cityjstate. Zip Phone <-r-?cs
r!".' _F Saker' '2<'
Contractor Address City/State Zip Phone
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Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? 0 Here U Report
zr�� rax� arrtxrr srawc r�rdbyv�«v>rracnrx Are you paying with your trust account? Q Yes 0 No
Is this a residential or c ommercbal project? 0 Residential ❑ commercial
If residential, is it: ® Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ 8ank ❑ Bar ❑ C:hun-h ❑ Hemet/Motel CI Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 5o years of age or more? ❑ Yes ❑ No If yes, you may need tip anted Historic Preservation
if this is for a demolition permit, what year was the building constructed?
if prior to 1975., you will need an asl� rise-v vncvrt to svW2 t with this app# rzilmn.
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Oescription of work r,�-ew:c> g � sa yv k' i _- _'`-;
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*If lawn sprinkierlbacktiow preventer, must list plumber. If first-time A/C, must list licwsed electrician.
Subcontractors: List the company noire yr GYy of Ft Collins l aw.,;V 0
Electricl,m Plumber.._-._.___........_ MKbankAl- .... -------------------- 'Rooter. ___.-_._._.- Oar
I hereby acknowledge that I have read this applii:3tion and state that the above infnnnabon is complete and correct. I agree to
comply with all requirements contained herein and city ordhames and state taws regulating building construction. I know that a
permit Is not valid until it has been paid and Imsed.
Applicant: 2
j Print Name: :i ` , ` Signature . \ Date .r1-..........
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