HomeMy WebLinkAbout636 BLUE MOUNTAIN DR - APPLICATIONS - 9/15/2011 (2)From Affordable Roofing Inc 1.970.207.0289 Thu Sep 15 09:19:25 2011 MST Page 1 of 1
City of¢ �,a
nc
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). ❑ Air Conditioning
13 Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
;E3 Heating Unit ❑ Lawn Sprinkler ❑ Mobile home replacement ❑ Roofing O Sewer Line ❑ Photo -voltaic
11 Ventilation ❑ Water Heater ❑ Water Line ❑ WoodlPeliet Stove (must be EPA certified, provide make, model and
manufacturer).
;Complete all applicable information on the application.
:Application #_� �l
For office use only
Incomplete applications will not be accepted..
Date q' - 15 . f
Job Site Address (required�)
Value of Construction (labor, materials, profit)
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;Property Owner Name
Address
City/State Zip
Phone
;Applicant Namel
Address
City/State F+,CbG A✓13Zip
Phone
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Contractor
Address
ckylstate Zip
Phone
Contractor City of Ft. Collins Sales Tax
Are you paying taxes here or by report?`Here
❑ Report
Sales tarnumbefrsrequrradbyaarnnaaMm
Are you paying with your trust account?XiYes
❑No
3s this a residential or commercial project? dential ❑ Commercial
If residential, is it: sDetached ingle Family ❑ Condo/townhome (single family attached) ❑ Duplex
Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank O Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
:.Is this building 50 years of age or more? O Yes ❑ No if yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
0pn& to 1975, yvu W11 need an asbestos assessment to submit with this application.
Of
*If lawn sprinkk(lbaddlow preventer, must list licensed plumber. If first lime A(C, must list licensed electrician.
Subcontractors: Usr the company name or City of Ft Collins!!tense
Electridan Pfumber Mechanical Roofer
"I hereby acknowledge that I have read this application and state that the above information is complete and correct. I agree to
comply with all requirements contained herein and city ordinances and state laws regulating building construction. I know that a
=permit Is not valid until it has been paid and issued. 1 I
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Applicant ;k =v 1n
Print Name:k r'(ct �+�-1 L`4� :' �gnahu4', �'�,� 1 �'! Date
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