HomeMy WebLinkAbout4123 VERBENA WAY - APPLICATIONS - 2/5/2015From Affordable Roofing Inc 1.970.207.0289 Thu Feb 5 16:13:23 2015 MST Page 2 of 8
rPlanningr Deveiapmeni_ & Transportation
C ,�, i'°=- 9' 291 N. College rave p.o. Sox 58C.
L��ti� Fort- Colllns, CO 8052
Phone 970-516-2740 Fax 22q-0-13',
OVEMR-THE-COUNII ER' PERMIT S 0P'll,LY
This application is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
0 Denolition (interiornon-structural) 0 Electrical Alteration (not service change) 7 Cos I_ioh;er D Gas Log
i!! Heatino Unit n i awn Sprinkler 0 Mobile 4ome replacement Q Rooting d Sewer Line 0 Photo -voltaic
Vsniilaiion 3 Water i-laater p VVaier Line L %Vood/Pellst S
manufacturer?. tove (must be EPA certified, provide make, model and
Complete ail applicable information on the application, incomplete applications Will not be acceDteei.
^Plpiicaiion B a�®_ �OZ Matz
r'ar office use only
30t, 51-te Address (required) - --
1liafue of Construotior. (labor, materials, orort�
`q-1 a verb_ e�-�a�l, &q � a q
PrOPeri}r Owner Name - r --
rl Address . r�yj5iate ZIP Phone
pplicant. game Address
I.l: CiiY/Seta) r� 41P�1 Phone q -r U
yCl �l �i jC. G� 1�
Cclltmccor _j Address t 2Ci-1 BUJ
s tYIS �i 4ip Phone
Contractor City of Ft. Collins Sales Tax r -----
.a.-raraura�srTs, db7alicontraacr_: Are you paying with your:rustaccount?ayes ' aid
Is _his a r`sidenUai or commercial project? _aResicentlat 0 Commercial tZ1d�l Zi0 IF residential, is it- single Family Detached 0 Condo/townhome (single family attacheri) ❑ Duplex
0 Multifarniiy (apar(ment) ❑ Garage
commarciai, is it: ❑ Bank ❑ Bar Cl Church 0 kotLe_Motel G Medical office Q OFic CJ Retail
Resourant ❑ Other (explain) _-
i is this building ep years ar' age or more? ❑ yes 0 No If yes•, you mayn66d fU Contact Historic Pr
f: i his Is Per a demottiion permit, what year was the building construcizd? esert2tion
ff pr%r io Z 9.7 , you wfl! r1eea an asbesins ors sm r to submir with this aDpJlcaUOn.
work
i "Ef lawn sprinklerlbackr?ow preverizr, nws lir licensed plumber. If 0r;,-time A/C, mural list licensed
Subcontractors: LICYrthe cnme3nynamea, CiiyofFCCoJlfns%icons_
_in'dc'ta.
1_ >'iumher _ c�echanieet ._. Roorzr
? hereDy acknowledge that! have read this application and state that the above infbrrnation is complete and correct. i agree to .
i al+nbly ;with all requirements contained herein and crZy or dinactces and state laws regulating building construcCfon. I know the a
} perm.: Es riot valid until It has been paid and Issued -
Applicant: _
Srint Name I rn \- Signature ---�`-