HomeMy WebLinkAbout610 S WHITCOMB ST - APPLICATIONS - 10/2/2013From Affordable Roofing Inc 1.970.207.0289,Fri Sep 27 10:45:38 2013 MST Page 2 of 2
Planning, Development &Transportation
City Of 0 281 N. College Ave P.O. Box 580
r.�, r, Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
This application is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
❑ Demolition (interior non-structural) O Electrical Alteration (not service change) ❑ Gas Lighter .❑ Gas Log
❑ Heating Unit 0 Lawn Sprinkler ❑ Mobile Home replacement )I Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation Q ltVeter Heater ❑. Water Line ❑ lAlood(Petlet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all -applicable information on the application. Incomplete applications wili.not be accepted.
Application # B 1 30 J 1: 9
For office use onty
Date 1e�-a-►3
Job Site Address (required) Value of Construction (labor, materials, profit)
11
PropertyOwner Name Address CitylState Zip Phone
Applicant Name-
AJGCovaabte
Contractor City of Ft. Collins Sales Tax #
Sales ter numberisrzvuiied byall con"'!W e.
City/State . Zip Phone 4 76 -
I'1 ). Tr ��� a �C Cf $aSa S , -ej6o o
Address ty/State Zip. Phone
Are you paying taxes here or by report? 0 Here ❑ Report
Are you paying with your trust account? ❑ Yes ❑ No:
Is this a residential or commercial project? Iff Residential ❑ Commercial
If residential, is It: Single Family Detached u Condo/townhome (single family attached) D:Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑otellMotel ❑ Medical office 0 Office ❑ Retail
C] Restaurant ❑ Other (explain) need to contact Historic Preseruatlon
Is this building so years of age dr more? ❑ Yes ❑ No If yes, you r» ay
If this is fora demolition permit,, what year was the -building constructed?.
If pl7cr to 1975, you will need an asbestos assessment to subunit mth this application.
VUI
Description of
I
10
*If lawn sprinkler/backtlow preventer, must list licensed plumber. If first-time A(C, must list licensed etecMdan.
Subcontractors: tlsntheCOMPanynameorCd of Ft Collinsl1ce17s2
H.Cuidan__�--- Plumber
Mechanical Roofer R— ig54 Other
I hereby acknowledge that 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 corvction. I know that a
permit Is not valid until it has been paid and issued.
Applicant: !�
=� -- `— pa
print Name: n^ �E t1>n i S Signature r