HomeMy WebLinkAbout328 DEL CLAIR RD - APPLICATIONS - 6/19/2013From Affordable Roofing Inc 1.970.207.0289 Wed Jun 19 10:29:31 2013 MST Page 2 of 2
p7annim3, Development & Transpottwean
281 N. College Aye P.O, fxix 580
FOrt Collins, CO C0524
Pl1(X1e970.41&2799 Fax;!?4-Riau
OVER- 9"F4DOUNTER PERMITS ONLY
This application Is to be used to apply for the £ollo ng PentIfts ot1IY (check -all that apply). U Air Condltinning
%� Oemolt'tro" n (intsrbr non-stnrdural) p Elwrical Alteration (rtnt service change) L7 Gas L;gnter O Gas Log
pleating Unit p Lawn Sprinkler ❑ While ticme replacarnant � 72oO0ng p Sewer Line t7. Phpto-voltaic
U nufa t user p Water Heater t3 Ybaler Line Ij 11vood'Pettet Stcve (must be EPA c_rt ffi' d. provide ma&o, model and
manutactarer).
COtttplate Olt an cal gf0rmetion on the application. Incomplete applications wait no qbe Accooted
Acplicatian VII e���0-- Late �( )
Job Site Addre" (Xim- ari)
I,rcperty Owner Name
Applicant Name
Contractor
Cnn?r ctor City of Ft Collins Sales Tax
P_.....__ _...__ Value +tfC�onl OO on (mtm; rraterLals, prong
Rthiress C7LYlSiatp - 7qi whOrte
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Addresa CitYM/Sta. —zip
Address
ri W<
Zip
Phone 9 713 -
Phone
Are i'r'u. pavans taxes here or by report? D Here; 0 Repart
Are VIV paying -with yolir trust aa:omit? ❑ Yes ❑ No
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Is this a retwen-- -- —.'
tiat n:- rcvrirtterdai ii.•vjc; t? R�Edentlal
If resid tal, is It: M Singie Family oksBr. e_d .p Coridortpvmhume ( rgte famtry atLehnd) t l Hex .-.� ❑ Multifamily (apartment) C Garage
If ccmmetcal, m it; CJ gjrp: ❑ 13ar CI Chu, Ci NOteJD!txe: p l.7edlr7 cF.'rCa ❑ OfricC (7 Retail
❑ Restaurant ❑ Otli�' feCi Ho
IS L'Hs Mlilct[n 50 0 ) .._-
9 years Or ntr,rp. GYes t]f40 lrlgS,jtY/n.?Y neciy a>c.N:f2cti!i3tcvicPmsawllon
If t:is is far a demolition {�rmlt, what year was L,a btdlc9ng cint+ructc
ffAlor .—..`...----• Jam' - nftvan avpk—.,Cgassr..zm0nt 4�!uM>r7-+dr?A L"r3Gp[�,ra(iort
Description of Kwk
---- -- if Won tprink)er/tiatitfiOw Vre�renk�r, tntrlt Ilst Gxnstd plumhar. If fir r"lme AJc, m'rA It:t limnsed 6ectritian.
! SuheantraGteMa:Uy7(rie ru:geariynameco G(rnlRCadrrtc /s'ersed
hunprr .—•T Medl3rNiat
1.. _....__. R ............_— Amiss
11'Mm-by attndwL-CUP that t haeat mad'mt, appli;a::rn and state that the above information is ----' -m- - . --
amply mth,all reauImnlLnts res"Ined: tierefin and cRy mdina sea-and.ctate laws ra uiatln oxrHtleta and ayrrett. t sgerw to
Permit is not valid until It has been Paid Md issued. 0 g ouctlin4toast'nWtion• 1 linar that a
t
Pent flame: nru -J e.vt-A i 1,14 S 5ignatura...
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