HomeMy WebLinkAbout925 COLUMBIA RD - APPLICATIONS - 10/22/2014 (5)From Affordable Roofing Inc 1.970.207.0289 Wed Oct 22 16:16:46 2014 MST Page 6 of 10
City of Planning; Development 8c Transportation
281 N. College Ave P.O: Box '580
Fort Collins, co 80S24
Phone 970-416-2740 Fax 224-6134
LIVER HErCOUN 1 EIS PERMITS OiVLY
i his application Is to be used to apply for the following permits only (check all that apply). ❑Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Uni( ❑ Lawn Sprinkler ❑ Mobile Home replacement: ❑ Roofing ❑ Sewer One 0 Photo-voltalc
❑ Ventilation ❑ Water Heater ❑ Water Line 0. Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete.all applicable information on the application. Incomplete app((cations. Wtil not be accepted.
Application # B 14113 3% Date
Far office.use only
Sob Site Address (required) Value of Construction (labor, materials, profit)
oo.
Property Owner Name Address City/State si,; +-k Zip
Phone 3 03
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AuName .Address City/State Zip Phone
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Contractor Address /State Zip phone
Contractor City of Ft. Collins Sales Tax #
-SWa'tax nuMtWfsr�qukWbyah'conh-a tom Are you paying with your trust account? @`Yes ❑ No
Is this a residential or commercial project? JR�Residentlal ❑ Commercial
If residential, is it: "Single Family Detached Q Condo/townhome (single family attached) El Duplex
❑ Multifamily (apartment) ❑ Garage
Ir-mmmer> lai,'is it: ❑ Bank p ear ❑'Church p Hotel/Motel ❑ Medical office ❑ office ❑ Retail
❑: Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No Ifyes; you Mayneed to contact HistorfcPreseruatl6n If this is for a demolition permit, what year was the building constructed?
1)`P,wor to 1975 you uvi# need an asbesms,assersment to submit with this app!/c &12rL
;ion of work.
XIf lawn sprinkler/backflow pr, v ter, must iist iicensed
If firstAlme _A/C, must list licensed electrldan.
Subcontractors; Ust the companyname or Gfy ofa.Cialirns /ice175�e #
bievArian Plumber ^•_ Merhanircal Roofer - 1959 Other.
I hereby acivrowledge that I have read this application and state that the above information Is complete and correct, i agree to
comply i in ail requirements cvntalned herein and city ordinances and state laws regulating building construction. I know thata
permit is not valid until it has been paid and issued.
Applicant: J
Name,
Print NaSignature %ry a