HomeMy WebLinkAbout925 COLUMBIA RD - APPLICATIONS - 10/22/2014 (8)From Affordable Roofing Inc 1.970.207.0289 Wed Oct 22 16:16:46 2014 MST Page 7 of 10
City, of Planning, Development; & Transportation
281 N. College Ave P.O. Box 580
art tens Fora: Collins, CO 80524
Phone 970-41b-2740 Fax 22+-6134
OVERaTH&COOPUNTEER PERN1111% ONI IF
This application is to be used to apply for the following permits only.(check all that apply). ❑ Air Conditioning
0 Demolition (interior non-structural) ❑ Electrical Alteration (not service change) Cl Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line 0 Wood/Pellet Stave (must be EPA cerl[ ied, provide make, model and
manufacturer).
Complete ail applicable Information on the application. Incomplete applications Will not be accepted-
Appifcation # �I�f 11334e) date
PorOfte use only
Sob Site Address (requtmd)
qd5 Coll )m h'
B 16 X::� / V (ue of Construction (labor, materials, prci t)
(p QPW Sao •oC)
rtu}ici ci owner �vame , A dress City/Stave 5u�f-�
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Phone 3d3
806
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Applicant Name
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Address city/state y/State
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zip
Phone q�U
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Contractor
J Address /State
ZIP
Phone
Contractor City of Ft. Coillns sales Tax
Sous tax numturtsrequired by all contractors
Are .you paying with your Trust account? "Yes ❑ No
Is this a residential or Commercial project? fR'Residentlal ❑ Commercial
IP residential,. Is it: Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
0 Multifamlly (apartment) ❑ Garage
If commercal, is it ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ OfFice ❑ R a
❑ Restaurant p Other (explain)
Is this building 50 years of age or more? ❑ yes Q No ,Ifyos, you may need to contact Hl&adcPm5ervation
If this. is For a deinoiltiort permit, what year was the building constructed?
If prior to I975, you ran% need anasbastas assessment to submFt with this applkabon.
ion of work
V lawh sprinklerjbackffow pr nter, must list licensed
If first-time A/c, must list licensed electrician.
Subcontractors: VstG're company name or City of Ft CoGhs license
1116an Flumbar MechWaal
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I hereby acknoWledge that I have read this application and. state that the above.information is complete and correct. I agree to ..
comply With all requirements contained herein and M ordinances and state laws regulating building construction. I know that a
Permit is not valid until it has been paid and issued.
AppiiCai!tt; �^ ,
t'rint Name i Signature 'g'ti a as