HomeMy WebLinkAbout925 COLUMBIA RD - APPLICATIONS - 10/22/2014 (6)From Affordable Roofing Inc 1.970.207.0289 Wed Oct 22 16:16:46 2014 MST Page 8 of 10
City of Ptanningr Development & Transportation
281 N. College Ave P.O. Box 56o
art CoWns Fort Collins, CO 8052.1
Phone 970-416-2740 Fax 224-6134
0VEFIR"I"iwE-COUNTER PERM111rS. ®NL�
This application Is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
❑.Demolition (interior nonstructural) 0 Electrical Alteration (not service change) ❑ Gas Lighter 0Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line Cl photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ WoodlPeilet Stove (must be EPA ce
manufacturer)_ rtined; provide make, model and
Complete all appitcable inforMation.on the application. Incompleta applications will not be accepted.
Application lI J3GI Date
For Office use only
30b Site Address (requ/red)
90 col m la'c�
d B �� '� �
Value of Construction (tabor; maieriais
�yoc� - o�
, profit)
Property Come Name Address City/State Su l-2 Zip
W SiOn MIS C_ondorni )kU_,) a$50
1) LS.SSa ' t�o�t Qellond.Dctoo cct4'F3�a5
3 c
PCIS�n
Annpplitani Name
rot-c1n.1..e r1Z�o ��,
Address
City/State zip
7lat
Phone q.7U
Contractor
a t�t
Address
/State
2tp
Phone
Contractor City of Ft. Collins Sales Tax #1:
Sales raxnumbaNsreWradbyaffcpnftanzorm Are you paying with your trust account? Erles ❑ No
Is this a residential or commercial project? Residential ❑ Commercial
Ir residential, Is it: -WSfngle Family Detached Cl Condo/townhome (single fariiliy attached) ❑ Duplex
❑ Multifamily (apartment) 0 Garage
If commercial, is It ❑ Bank ❑ Bar ❑ Church 13 Hotel/Motel ❑ Medical otFce !❑ Office ❑ tall'
❑ Restaurant ❑ Oilier (explain)
1.7 this building SO years of age or more? ❑ Yes ❑ No rfves yournaynmdtocontactHistnr/cPresenatian
If this is for a demolition permit,. what year was the building, constructed?
If prior to 1975, you py///'need .an asbestos assessmenrto submit vdtb this app/l ,ycn.
Of
x1f fawn sprinkler/backflow pr titer, must list licensed
If first-time A/G must list licensed electrician.
5"Contraeiors: L&t the Company namB or LSiy afFr Col//ns &msa 9
Elec�trfelan Plumber.
Mechanical Roofer —1is5 other
I hereby acknowledge that i have read this application and state that the aboveinformation is complete and correct, I agree:tn , comply with all requirements contained herein and Uty ordinances and state laws regulating building construction. I know that a
permit is not valid until it has been paid and Issued.
AppiFcanC: �-�
Print Name: Signature_ �'`�i q�o7 l a