HomeMy WebLinkAbout925 COLUMBIA RD - APPLICATIONS - 10/22/2014 (3)From Affordable Roofing Inc 1.970.207.0289 Wed Oct 22 16:16:46 2014 MST Page 4 of 10
Planning, DeVelopment & Transportation
281 N. College.Ave P.O. Box 56o
Fort CoWns Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6135
OVER-THE-OU"'OU1.. ER PERM S ONLY
This application is to be used to apply for the following. permits only (check all that apply). ❑ Air Conditioning
EJ Demolition (interior nonstructural) El Electrical Alteration (not service change) 0 Gas Lighter 11 Gas. Log.
❑ Heating Unit ❑ Lawn. li
Sprinkler 0 Mobile Horne replacement
manufacturer). ❑ Roofing a Sewer Line ❑ Photo -voltaic
13 Ventilation Cl Water Heater ❑ Waterne CI Woodipellst Stove (must be EPA certified, provide make, mode( and
Complete all applicable information on the application. Incomplete 013lications will not be accepted.
Application # 6ILA I I Date
For ofice use only
Sob Site Address (required) Value of Construction pabor, materials, profit)
rroperny uwn�er Name Address Gty/State su; f-2
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Phone
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Applicant Name
'
Address
City state
Zip
Phone q-70
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Contractor
Address
/State
Zip
Phone
Contractor City of Pt. Collins Sales Tax ;_
Salesbxnumber ;srequkedbya(imntracinrs
Are you paying with your trust account?
LR Y ❑ No
Is this a residential or commercial project? RResidential ❑ Commercial
If residential, is it: Single Family Detached ❑ CandoltoWnhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If Commercial, is It: ❑ Bank ❑ Bar ❑ Church .0 Hotel/Motel ❑ Medical office ❑ O{fice 0 Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? p Yes O No Ffyes, you mayneed to contact HlsYor/cPresetvation
If this is for a demolition permit;, what year was the building constructed?
IFprlor:L'o 192S, you w/// need an asbesi25455e sment to svbmit with this aopbcatlon.
of work
*-If lawn sprinkler/backflow priOWer, must list licensed
9
If first-time A/C, must list licensed elecbiclan,
Subcontractors; "st bJe 02faParK Aqme of City of FtWlIns/!tense0
8ectAclan Plumber Me&antcal
Raafer - i 5 Other.
I hereby acknowledge that I have read this application and stabe that the above information is complete and correct, I agree to
COMPLY with all requirements contained herein and city ordinances and state laws. mgulating building construction. I know that a
pereslt is not valid until it.has been paid and issued.
Applicant: - ///
Print Name: r : Signature f�iya a.