HomeMy WebLinkAbout1320 SOUTHRIDGE DR - APPLICATIONS - 4/12/2013From Affordable Roofing Inc 1.970.207.0289 Wed Apr 10 14:35:06 2013 MST Page 2 of 2
,.+�3tv a$, Planning, development & Transportation
r r t K 281 N. ColhN Aven
<" .c" ;f : ve P.O. box 5S0
\... \ L.,:.. Fart Collins, CO 80524
f 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). O Air Conditioning
0 Dernoldion (interior non-structural) ❑ Electrical Alteration (not service change) 17 Gas Lighter r:3 Gas Log
CJ Heating Unit ❑lawn Sprinkler 0 Mobile Home replacement 'P Rooting O Sewer Line 0 Photo -voltaic
U Ventilation 0 Water Neater D Water tine ❑ Wood!Pellat Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application #__ao I .P) .1, _--. Date
x aft e use arty
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is this a residential or wmrnerciai projery? W Residential Q Commercial —
If residential, is it: q Single Family Detached 11 Condo/townhome (single family attached) 0 Duplex
❑ Multifamily (apartment) 0 Garage
If commercial, is it: 0 Bank Q Bar C) Church 0 Hotel/Motel D Medical office ❑ office Cl Retail
Restaurant C) Other (explain) _.---- Is this building So years of age or more? O Yes ❑ No If ycv, you Iraaynt'Fd R? Coalacr HisYor!c prec fiV�1ri
If this is for a demolition permit, what year was the building constructed?
on
— .- -----------------.._... ...
I prtUr ire 1975 yet +viil nc� an as/�,sfc>J a-sse�snrent to submit wtiNT this-
Description of work
*If lawn s{xinkter/backnow preventer, must list licensed plumber. If first -[role A/C, must fist licemsed ek:rsrioan.
Subcontractors: List the cn-z4 9 iy name fir City of Ff rz?/Itils &6r? e'
0e trician-__-_----- alumt>Pr_--- Nk t hanical
RrxAer - (L--S9 other
I hereby acknowledge that i have read this application and state that the above information is Complete and correct. 1 agree to
comply with all requirements contained herein and city ordinances and State caws regulating building Construction. I know that a
permit is hat valid until it has been paid and issued.
Applicant: 11
Print Name: can Ys t 1t� 5... _ signature — -- Daw