HomeMy WebLinkAbout611 LAPORTE AVE - APPLICATIONS - 7/29/2013From Affordable Roofing Inc 1.970.207.0289 Mon Jul 29 09:21:29 2013 MST Page 2 of 2
Planning, Development & Transportation -
ity,,CC 281 N. CnileW Ave? P.O. 9QX 580
�...,\
`,� -\�: �\£� Fort Collins, CO80524
�,,.•. w�i.... Phone 970-416-2740 Fax 7.24-6134
OVER-THE-COUNTER PERMITS ONLY -
This application is to be used ta.apply for the following permits only (check -all that apply). U Air Conditioning
o Demolition ttntentif non-strucluta4 U Elecbiral Alteration (not service change) G G8s Lighter E7 Gas Log
❑ Heating Unit D Lawn Sprinkler M Mobile Hoene replacement t. Rouflng ❑ SewerrL.ine l7 Photo-vottaic
CI Ventilrstion D Water Heater C) Water Line C1 WoodlP -ellet Steve (must be EPA. certtied, provide make, model and
manufacturer), -
Comolete all applicable intortratfon on the application. Incomplete applications will not be accepted.
Application 1t........ Date -------------------
hxo/tihcrr» a-uy
]ob Site Address &equerod) Value of Construction (tabor, matertals, pmfit) 1
..Property Owner Name Adrh-ss Clty/5tnte Zip Pttale zip
r, t-�..� ,.2 r•l�vv4 t' T Ce:ft44 L.0 G65:., 718;T i
Applicant NanV. Address City/State Zip - Phone Q'7' -
f
}iy--iV<'�2Po�R t'. Dat9`n .�. ✓�C'. dt'1 ..e.. 'l-tiff^. TL_d' �'S i.-C6 �'OSacS_ �t U7 "r.�CtOC
Contractor_
'- - Arklrres ntY75 Zip .Phone
Nso,kiytdr
Litt of Ft. Collins Saies Tnx & Ar_ you Paying tares lie tt or by report? ❑ Nair: C.nar+drr lrrryudedrW dO'<ontr-ac:a•c Are yn:i tidying with yciur lrlist. armunt? C3 Yr3 f) No
thts a resdentWl or:tc5ulxveat project'? 5QRe5tdenbal ❑ Commerdal
If residential, is it: Stngle Fa"ly netadied ❑ C.nrtdojtowhdronre (angle tamly attaci Ted) - L] fhniler `--- -
II 'U Multifamily(apartm2tlt) --El Garage
if Corrunerchal, i5 it: ❑ Bank 0 Bar ❑ (Yiuri4h ❑ Hole)/M00 ❑ MedreSt edict ❑ Office 0 Retai:
❑ Resta:nant ❑ Other (explain) -_------------- -------- .__------- --
--- Is tiuc Uuilcii ig So years of age cr rnrre? U YeS ONO rfyes, you nz:y reLV rV contact t iS&Ve p,2sa�3tmn
!f this'is fiv-a dem alitldn permit, wfatyear was the buiMiv mmtructed?_----------- ------ ___-----
-- ..
ii priex m 151./S, you teNti neeei.wt ask:shts asar.zs»x --- to s----- en*h to s appdcarirx:.
Description of work
- - —
xlt lawn sprinkWrRtaddlow prevenRv-, roust list ii�nsr-b PlUmher_ If (u^,.-tome A/C, mus[ Ipt Frenwil a rt rman
SubcontracW.r. iMthe cnn)Lexry mane a Liry c/ft Cc✓ti� Jlcrnse d
FItV11DCr_--.._._.___.-.— MectanKal....._—____.
Eleat+toan.... _...... _..---- --- RO^•@r _----'-'r
- -- -
I hereby a&nwMedge UOt I ht c read this aWrrt abort aM state mat the above inmvil It69 is ldjjjq to and corn. I l agree to 1
comply with all regtrtrenVrm contained herein and dty ,dirano, .1rhd 11 laws reyulaUng txdlding construpion. 1 brow that a
permit Is not valid until it has been paidand issued-
Applicant: r ., ._..... ... Date._._ 3--_
A 4 S Signature. __..—...._.__........ t.....
Print Nam¢:-..^..----- � e.>, e• t K _ .. .
e