HomeMy WebLinkAbout925 COLUMBIA RD - APPLICATIONS - 10/22/2014 (7)From Affordable Roofing Inc 1.970.207.0289 Wed Oct 22 16:16:46 2014 MST Page 9 of 10
�, �¢ Planning, Development &Transportation
281 N. College Ave. P.O. Box 580
Fort Collins, CO 80524
Phone S70-416-7740 Fax 2246135
O' ER-THEwCOUNTER PERMIIia ONLY
This application Is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
❑ Demolition (interior non-structural) El Electrical Alteration (not service change) 0 Gas Udhter 0 Gas Log
❑ Heating Unit 0 Lawn Sprinkler ❑ Mobile Home replacement 11 Roofing ❑ Sewer Line 0 Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Waterline ❑ Wood/Pellet. Stove. (must be.EPAcertilied, provide make, model and
manufacturer).
Complete all applicable information on the application. incomplete applications will not be accepted.
Application #,
1b I�i 113�a
For office use only
Date
3ob Site Address (required)
Ca
value of Construction (labor, materials, profit)
d ��
q05ern 1��a
77M. 00
Property Ow er Game A dress City/State Su L' 1-- Zip
YYIi . `ils C ,ndoMknjujn ) a850 M6bla.nd Or loo �'+eo(4
Phone 3 03
Applicant Name
Address City/State Zip
Phone cl-70
AuUr
21-1 W , 6 UT=
IX-7700
Contractor J
Address - /State Zip
Phone
Contractor City of Ft. Collins Sales Tax
# �
Soles�enumberisrenuiriibyalfwntractom
Are you paying with your trust account? Lci"Yes
❑ No
Is this a residential or commercial project? �k'Residenflal 13 Commercial
If residential, is it: -trSingle Family. Detached 0 Condo/townhome (single family attached) 0 Duplex
0 Multilamliy (apartment). ❑ Garage
4 If commercial, is it: ❑ Bank ❑ Bar ❑ Church 13 hotel/Motel 13 Medical office ❑ Office Q Retail
f ❑ Restaurant ❑ other (explain)
Is thls building 50 gears of age.or more? E3 Yes 13No If yes, you may need to contact lfstodc Preservation
If this is for a demolltlan permit, what year was the building constructed?
j Ifprior to 1975, you will need an asbestos assessment to submit moth this application.
of work
of lawn sprinklerlbacidldw printer, must list licensed plumbW If first-time A/C, must list licensed electrician.
'Subcontractors: List 'thdcompanynameorGYyofFtCof/Ins11cenm0
Elec7lclan Plumber . Mechanlcal Roofer Other
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 city ordinances and state laws regulating building construction. I know that a
permit Is not valid untR it has been paid and issued.
Applicant:
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