HomeMy WebLinkAbout919 MILAN TERRACE DR - APPLICATIONS - 11/11/2014From Affordable Roofing Inc 1.970.207.0289 Tue Nov it 15:11:25 2014 MST Page 2 of 2
City of Planning, Development&Transportation
���6ggg���l 281 N. College Ave P.O. Box 580
�;. t Collins Act Fort Collins, CO 80524
/ Phone 970-416.274C Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply), ❑ Air Condiooning
17 Demolition (interiornon-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
Cl Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation 0 Water Heater 0 Waier 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 #. j1411.15:1 , Date
For office use only
306 Site Address (requred) Value of Construction (tabor, materia(s, profit)
(i T-ef r olz I 'p' ICE, =:&� �C � _
Property Owner Name Address City(State. Zip Phone
'itt-
Applicant Name Address City/State Zip Phone q•70
1R) � �.o a 1-1 LAD Tr 1b� S��a aa' ono
Contactor Address /State Zip Phone
Contractor City of Ft. Collins Sales Tax s
Sete; tar numberis rmquzmd by aU contractors. Are: you paying with your trust account?Yes [I No
Is this -a residential or commercial project? ! TResldenttal 17 Commercial
If residential, is it; -Ir-51ngle Family Detached ❑ Condo/tvwnhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commerdal, is it: ❑ Bank ❑.Bar '❑ Church ❑ HotelJMotel Cl Medial office ❑ of,Sce ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 3D years of age or more? ❑ Yes Cl No If yPs, you mayneed to cnntactHistaficg- servaGon
If this is for a demolition permit, what yearwas the building constructed?
Ifprlor io 1975 you will need en asbe5[0s assessmentro submit with this application.
Description of work aY { X o e
xIf lawn sprin der(baddlow preventer, must list licensed plumber. If first-time A(C, must list licensed electrician.
f subcontmctor=Ditfhecompany nameorCityOfFcLbg11s5lkenseA'
Elecridan Plumber^ Mechanical Roofer Q-\SS°i Other—_
I hereby acknowledge that 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 until it has been paid and is uad.
Applicant:
Print Ni rn— i ,n' Signature ��-�i /-3--nab•