HomeMy WebLinkAbout925 COLUMBIA RD - APPLICATIONS - 10/22/2014 (2)From Affordable Roofing Inc 1.970.207.0289 Wed Oct 22 16:16:46 2014 MST Page 3 of 10
City 4 f Planning, Development Sc Transportation
281 N. College: Ave P.O. Box 580
55rt thns Fort Collins; CO 80524
Phone 970-416-2740 Fax 224-6134
OVER-�"64#00 NITER PERINI aVa ®1➢Ll�
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This application Is to be.used. to apply for the following permits only (check all that apply), ❑ Air Conditioning
❑ Demolition (interior non4tructural) ❑ Electrical Alteration (notservice change) ID Gas Lighter ❑ Gas Log
0 Heating Unit ❑ Lawn Sprinkler 0 Mobile :-forge replacement ❑ Hoofing ❑ Sewer Line ❑ .Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ WoodiPellet Stove (must be EPA cert"tfted, provide make,, model and
manufacturer)_
Complete ail applicable information on the application. Incomplete applications will not be accepted_
Application # eIq II 33,4 Date
For o tfce use only
yob bite Address (required) Value of construction gabor, materials, profit)
��S Coic�rm •a d B « �. a. Too. no
l Property Owner Name Address City/State 5-u 1 4-t zipPhone
YY1i idhHitt 5 d�M� o a 50 UUlG 6(9Lnd0C (0 4Z+6bl4n
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Applicant. Name Address City/State Zip
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Phone 9-70
o ' a l-i Lk) , n FTC,
20-^OU0
Contractor J Address /State Zip
Phone
Contractor City of Ft Collins Sales Tax
SalastaxnuMber&nwiredbya#coni araam. Are you paying with your.trust account?
/
Lc1'Yps ❑ No
Is this a residential or commerclal project? R'Resldentfal ❑ commercial
If Pesldential, is it: Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is il: El Bank ❑ Bar ❑ Church 11 Hotel/Motel ❑ Medir i ofi)ce ❑ office ❑Retail
❑ Restaurant ❑ Other(explain)
Is this building 50 years of age or more? q Yes ❑ No Ifyes, you may need to contact Himbncpreswwbon
If this Is Fora demolition permit, what year was the building constructed?
If pn'ar to 1975, you twil need an asbestos assessment to submit wiw this application.
Description of work a Y ota w e I
Y,64J I&=`
*If lawn sprinkler/backflow pr r, must: list licensed: plumb6i if first-time A/C; must list licensed efect1dan.
Subcontractors: tisl the mmpanyname ar alyofFrCollinskense is
€Iectildan Plumber Mechanical Rooter. ?L-1959 other
I hereby acknowledge that I have read this appilcatlon 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 construction. I knowthat a
permit is not vaild until it has been paid and issued.
Applicant,^
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E'rint Hleme:r rt ti � -e � ih S signature