HomeMy WebLinkAbout915 THORNHILL PL - APPLICATIONS - 10/16/2013From Affordable Roofing Inc 1.970.207.0289 Tue Oct 15 12:26:10 2013 MST Page 2 of 2
planning, Development & Transporttati;on
281 N.' College Ave P.O. 13ox 580
Fort Collins, CO 80524
Phone 97047.6=2740 Fax 2Z4-6134
OVER-THE-COUN :ON
This application is to be used to apply forthe following permits only (check all,that apply). CQ Air Conditioning
❑ Demolition (interior non-structural) II Electrical Alteration (notservice chance) . E7 Gas Lighter Q Gas Log
Q Heating Unit Q Lawn Sprinkler E Mobile Home replacement '19 Roofing 0 Sewer Line ❑ Photo -voltaic
Q Venti-3afon _QsP
}Nar Heater 1 < plater line B iivoccYpeiiet Stove (mastbe EPA certified; provide makes, model ant
manufacturer)-
completealIapplicableinformationon-theapplication- Incomplete applicafionswill not beaccepted-
Application V 0 -r,43 Date 1 U- 1 o -1 3
Fnr �ffire use only
Jab Site Address (iaquirer) Value of Construction (labor, materials, profit)
15 Int ��. a133- 00
Address City/State Zp Phone Zd
Property Owner Name 53v -- Phone
U
Applicant ame
Address Cty/slate. Zip Phone q?a-
Vic
Coninclo-r
1 Address City/state Zip Phone
CS�actorCty or Ft Collins Sales Tax # Are you paying taxes here or by report? Q Here ❑ Report
sales LaxnUmb�rls used byaU cone Are you paying tivith your trust account? 0 Yes a No
s ihisa residential or mmmerdai projeci? 9Res1dential E1 Commercial
I residential, is it: 1R Sngle Family Detached , Q C0ndo/t:)1AMhome (single tamilyattached) 0 Duplex
p Multifamily (apartment) ❑ Garage
If commercial, is it: [I Bank ❑ Bar El Church 0 Hotel/Motel C3 Medical office 1? Oiliice Q Reim[
Q Restaurant Cl Other (explain)
is this building 5C) years of age or more? D Yes ❑ NO If yes, you ataynEed to ConioctdistoriCPrrservarion
If this is for a de nortio iw' ,;E rthat yearwas the building mrs*ucted,? -
_uiil1 nppd an 75hE5tL?5 assessment to SUfJIIJIt with this app%/ral7oll.
Description of
S�
3`If lawn sprinkler/baddiow preventer,'must list {icensed plumber. If first-time A/C must list licensed electridan-
SubcontractarssL-Sf6haCrsnpanynameorGiyoiFtColCirs/fcensa ?-
53ectriaan Plumber
MechanIcal Roofer R— igSII Other
r hereby admowSedgethatT_ have read this appft�tlon and state'thatthe above information is complete and correct- I agreeto
comply �vitii all requirements contained herein and city ordinances.and state laws regulating building construction. I know that a
perndt is not valid until it has been paid and issued.
Applicant. "j—e-V w
print Name'
Date 10 t I 3