HomeMy WebLinkAbout612 MARIGOLD LN - APPLICATIONS - 11/11/2014From Affordable Roofing Inc 1.970.207.0289 Tue Nov 11 16:28:47 2014 MST Page 2 of 2
Flirt CoWns
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Planning, Development &Transportation
281 N. College Ave P.O.. Sox 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134.
This application Is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
El Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
17 Heating Unit ❑ Lawn Sprinkler ❑ Moble Home replacement ❑ Roofing ❑ Sewer Lide ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater Q Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, Model and
manufacturer).
Complete all applicable information on the application, Incomplete applications will not be accepted.
Application 9# Date
Forof,ce use only
Job Site Address (regrdred)
maldqcm LVX
Value of construction Qebor, materials, profit)
SX I o cx")
Properly owner rlarre Address
C�reo,mc+.4
City/State Zip
Phone
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Applicant Name Address
Citylstate Zip
Phone of i v
AUOr-c1rh zoo a1-1 LA)
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Contractor Address
/state Zip
Phone
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Contractor City of R. Collins Sales Tax -*
Safes sax num6_=rtsrequ)5wdby alrccntrectors.
Are you paying with your trust account? X'Yes
.❑ No
Is this a. residential or commerdal project? -R$ Residential L7 Commercial
IP resldential, is it -r�rSingie Family Detached ❑ Condo/townhome (single family attached) ❑Duplex
0 Multifamily (apartment) ❑ Garage
E commercial, is It: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ On, 0 Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes 01 No If yes, you mayneed to con&-ct Hlstoiic PreseruaDon
If this is for a demolition permit, what year was the building constructed7i
-prior
it io 1975, you wi/l need an asbestos assessment to submit with thfs application.
Description of work ar c VjV- 4�19 5
_
I
V lawn sprinklerybacknow preventer, must list licensed plumber. if first-time AIC, must list licensed electrician.
Subcontractors Lfstthe comµanyname or GtyofaColtins license IF
E19M!d2n Plumber mechanical Roofer 7-11RE59 oilier _
1 hereby admowledge that e-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 lmowthata
Permit is not valid until it has been paid and issued.
Applicant:
Print Hame' 1 r 5 Signature r+ii 1 l ll Iq