HomeMy WebLinkAbout4625 CHIPPENDALE DR - APPLICATIONS - 4/13/2015From Affordable Roofing Inc 1.970.207.0289 Wed Apr 8 10:40:14 2015 MDT Page 2 of 2
Planning, Development & Transnortab
Fa , 2131 N. College Ave P.O. Bdx S80
ori CoWns Fort Collins, CO s0524
Phone V0-41&2740 Fax 274-6134
OVER-Tn&COUNTER PERMITS ONLY
T his application'is to be used to apply for the following permits only (check all..that dpply). Q'Air Conditioning
❑ :Demolition (interior non-structural) El Electrical Alteration (not service change) :b Gas Lighter ❑ Gas Log
❑ Hewing Unit O'Lewn Sprinkler ❑ Mobile Home repiac.amepi 13 Roofing. Q Sewer Line O Photo -voltaic
❑ Ventl tion U.Vdatar Hester ❑ Water Line ❑ Wood/Pellet Stove (must be. EPA certitled provide matte; model end
manufacturer),
Complete all applicable information an the application, Incomplete applications will not be accepted.
Appl#cd)xcin # ��� G 25 H S Date'
For omi;d use only
yob Site Address (required)
191.Us of'Cotiszrud9on (labor, materials; profi'c)
y bChippenchle�
1 Oil
IPrope' Owner Name Address
City/State Zip
Phone
T&w\n .
Applico-nt Name Address
12z' al-t
city/State Zip
W..
phone q-7 U
2U7-00
Contrar y Address
-diY/Smte Zip
Rhone
1
Contractor City of Fr. Collins Sales Tax 4
gees axnr�mcsrtsuirectbyzircun�zcror
Are you paying with your trustaccourit?
Yes No
Is bits a'residential or commerdal Odjeci-? �R'Residential 17 Commercial
1 P resldentlal, is iti )k'Single Family Detached 0 Condo/townhome (single family attached) ❑ buptex
❑ Multlt roily (apartment) ❑ Garage
if commercial, is it: ❑ Bank ❑ Bar Q Church ❑ Hotd/Motel 0 Medical ofice ❑ Office ❑ Retalt
j ❑ ltcstaurnt. D. Other (explain)
j is this building SD years of age or more? Cl Yes II No ITyes, you nwyneed to mnta tR1storle Preservabw
If tills .is r`er a demolydon permit;, what year was the building consbructei?
If prior is 197T, you will {geed an asbast s ammzmant to, b, r mdm p4fs apple on
of work
of lawn sprin1der/bacicFlow preventer, must list licensed..plumber_ If first-fte A/C, must- list licensed elAbrician..
Subcontractors: Us<.drec=panynameorCrrryofF LbAinslirerx? : Elect.ldaA Plumuer Medlani¢el Ramtr Z-1g59 Other.
E ?.hereby acknowledge that! have read this application and state that the above information is complete and correct. I agree to . _
i comply nqth all requirements contained herein and city ordinances and gUbe lawsaegulabng building construction. = Imow that a
pems tis notxalid until it has been paid -and Issued:
0
Applicant: `,
Print fUanier Signatura % (TIis.
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