HomeMy WebLinkAbout925 COLUMBIA RD - APPLICATIONS - 10/22/2014 (4)From Affordable Roofing Inc 1.970.207.0289 Wed Oct 22 16:16:46 2014 MST Page 5 of 10
City. of Planning, Development &Transportation
281 N. Coliege.Ave P.O. Box 580
Fdrt Cothns Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6135
OVERmin PERMITS, ONLY
This application Is to:be used to apply for the following permits only (check all that apply), ❑ Air Conditioning
17 This.
(interior non-structural) ❑ Electrical Alteration (not service change) a Gas Lighter ❑ Gas Log
❑ Pleating Unit El Lawn Sprinkler O Mobile Horne replacement ❑ Rooting ❑ Sewer Ube ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line 17 WoodtPelldt Stove (must be EPA certi`ied, provide make, model and.
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Applicatlon f'W' 131141133(p Date
For office use only
Site Address (requffed) Value of Construction (labor, materials, profit)
�5ColumU0_ C�BI� � -legoo .oC
eSion rty Owner Name //QQ����- 1 ,�� �A,gdress ��JJ1 City/State so; t Q Zi�R . Phone 3 0
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PP ican>: Name Address City/State Zip Phone q-7
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Ccm[rat#ar Address /State
ZIP Phone
Contractor City of Ft. Collins Sales Tax a
ssnscaxnumher&M9'iradbyaucontractors. Are you Paying with your bust account? p'yes ❑ No
Is this a residential or commercial project? IRResldentlai IJ Commercial
If residential, is it: .rSingle Family Detached 0*Condo/tnwnhome (single.famlly attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, 1s.1t: CI Bank ❑ Bar ❑ Church ❑ Hotelftiei 0 Medical office d Office Q Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? 11 Yes 0 No Ifyes, you may need to contact HIstu c Prieservahron
If this is for a demolition permit, whatyear was the building constructed?
if pior to Z925 you wr71 need an asbesir,4s assessment to submit with this apput-aflon.
'If lawn sprinider/backflow pr liner, must list
If first-time A/C, must list licensed elecbidan.
Subcontractors: Ustthe CompenynanieorpiyofFrCbWhs-AcenSe+
Sec6idan Plumber Machanica Roofer 7=7 11159 Other.
I hereby acknowledge that I have read this application and state that the above information 15 complete and correct. I agree to . comply with all requirements contained herein and city ordinances and state laws regulating building oDnstructron. I know that a
permit is not valid until it has been paid and issued.
Applicant. -
Print Name 1SLN"o-%Signature _ �`nr aQ 1