HomeMy WebLinkAbout614 ENDICOTT ST - APPLICATIONS - 1/28/2013From Affordable Roofing Inc 1.970.207.0289 Thu Jah 24 14:39:34 2013 MST Page 2 of 2
of
F6ryt Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). 0 Air Conditioning
❑ Demolition (interior non-structural) 0 Electrical Alteration (not service change) ❑ Gas tighter 0 Gas Log
❑ Heating Unit 0 Lawn Sprinkler ❑ Mobile Home replacement 0 Rcxrfing 0 Sewer Line 0 Photo -voltaic
0 Ventilation Cl Water Heater 0 Water Line 0 Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer). 0
Complete all applicable information onthethe application. Incomplete applications will not be accepted. - 71,
Application # e13o () ) 0 ` ._ Date----aw �a
.............
For of ue use oily
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3ob Site Address (t wqulred)
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Value of Construction (labor, materials, profit)
Property Owner Name
Address
City/State Zip
Phone q -70
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Applicant Name
Address
City/State Zip
Phone ci'76
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Contractor
Address
Gty/State-_ Zip
Phone
_•-•.----------
Contractor City of FL Collins Sales Tax #
Are you paying taxes here or by report?
0 Here []'Report
s,A(es tar nemrbev & rertuimd by ae contractom
Are you paying with your trust account? 0 Yes ❑ No
Is this a resdential or commercial project? Z Residential 0 Commercial
If residential, is it: ® Single Family Detached 0 Cando/townhome (single family attached) 0 Duplex
0 Multifamily (apartment) 0 Garage
If commercial, is it: ❑ Bank ❑ Bar 0 Church 0 Hote[/Mowl ❑ Medical office 0 Office 0 Retail
0 Restaurant ❑ Other (explain) _••,•_•
Is this building 50 years of age or more? O Yes ONO If yes, you may rteEY1 to cnntarr Nist,xic t°nrvatian
If this is for a demolition permit, what year was the building constructed? .......... ---
Ifpnor to 1975, you wi// need an asbeshn assessment tc1 submit with this application.
Description of work
*it lawn sprinkler/baddiow preventer, must list licensed plumber. If first-time A/C, must list limnsed ebectridan.
Subcontractors: List the company name ar OrY of Ft C-ollrtxr &Ease ,9
4Other
reu tleetar+..._..-.....—...... _ Plumber -..-...---- Fiecik�n,r-alRoofer ice.._ } Zf-� ,'
I hereby admowlecige that I have read this application and state that the above information is complete and earrect. I agree to
comply with all requirements contained herein and city ordinances ar)d state laws regulating building construction. I know that a
permit is not valid until it has been paid and issued.
Applicant: i
Date r ti
Print iVame:,,•...+:".. ,, . __..-..... Signature ...-