HomeMy WebLinkAbout4900 NINEBARK CT - APPLICATIONS - 4/16/2015From Affordable Roofing Inc 1.970.207.0289 Thu Apr 16 09:51:37 2015 MDT Page 2 of 2
Fo t .dhns
Manning, Development & Tmnsportejoy,
281 N. College Ave P.O, Box 580
Fort Collins, CQ 80524
Phone 970-415-2710 Fax 224-613,4
This application is to be used to applyforthe follovliing permits only (checkallthat apply). ❑ Air Conditioning
❑ Demolition ('Interior non-structuraq ❑ .Electdcal Alteration (not service change) I Gas Lighter 11 Gas Log
❑ Heating_ Unit !J' Lawn Sprinkler ❑ Mobile Home replacement ❑ pooing. ❑ Sawar Line ❑ Photo: voltaic
iJ Ventile5on ❑ Water Heater Cl Water Line 123 WoodlPeliet Stove (must be EPA cerdied,, provide make, model and manufacturer}
Complete.all {pp ice I fo EM on the ppli&aSon�lncompiete aiViications will not be.accepteel.
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ApolICauon Z' , Dare
parer% use only
. 30f Site Address (require j
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V lue of Construction (labor, ma Is, profi)
Property Owner Name Address
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Cfivlstate Zip
Phone:
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1 pliclntZame Address
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Phone q 7Cj
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Contractor Address
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�` '/S� Zip
Phone
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ContractOr City of Ft Collins -sales Tax
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Arc you paying wilh your trust account? )(Yes
❑ No
is thisa resideribal or commercial p ojoi? ��YResitlentiai G Commerciat
nsi natal, is It Single Famlly Detached Q Condoltownhome (single family aftched) Q Duplex
Multiicmily (aparment) 0 Garage
if commercial, is it: ❑ Bank ❑ Bar ❑ Churc..h o HoC211Motei Gl i`7edicdl.or ce G Of -,-Ice ❑ Retail
❑ Restaurant El Omer (r�xplain)
Is this building 80 nears of age or.rnore7 1[]Yes ❑ No IPyas, youmaynead a7 mntactHistoricpres2rMffon
F faits is for a demol ltion permit, what year was the building consrrucbEd?
R p,Yor rG 19T�, yeti Mi1/1 need an asbestos assessment tta submit with 8rls applrcabon.
Description .of work
=I fawn sprinklerJUac4lo1v prevent2r, must list licensed. plumber I� *— 'me AIC, mus_ Ias6.2 lrcensetl electrician.
P.ubcOntractorss list the [brgrd9n) -name pl-CorafFtCo/!w heeizw
Els�lrt:n Plurntiar
Other
l berebyacamowledge thacI have read this apptication and stela that the abave irnonnatson is complete and cornett I agree tat
[o:,tDly teaU all requirements contained herein and cty ordinances and state laws regulating building construction_ s brow that is pernlit is not valid until it has been paid and issued.
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Printtisame: _ T r! V I { t_ IN n"rh TS Signature f' j ete � I [& 11J