HomeMy WebLinkAbout924 SANDY COVE LN - APPLICATIONS - 10/20/2014From Affordable Roofing Inc 1.970.207.0289 Tue Oct 21 10:15:50 2014 MST Page 2 of 2
City ®•®r� �f Planning, Development: & Transportation
�8 ' it� �� 281 N. College Ave P.O. Box 58G
16 "Fort Collins, CD 80524
Phone 970416-2740 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), 0 Air Conditioning
❑ Demolition (interior non-structurai) r Electrical Alteration (rot service change) 13 Gas Lighter ❑ Gas Log
t:r Healing Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line 0 Photo -voltaic
❑ Ventilation 0 Water Heater ❑ Water Line ❑ Wcod/Pellet Stove (must be EPA cer•.ified, provide make, model and
manufacturer).
Complete all applicable Information on the application. Incomplete applications will not be accepted.
Application 9 _$ Date
fbr office use only—�-.---"—." ---..
Job Site Addd�re�ss� (reryuired) Value of Construction (labor, materials
,profit)
r17 _x t00 - 3
PrapertY Owner Name Address U
Cy/State Zip Phone
�o►rtoac�. Applicar: Name Address City/state Zip
A Or, ? Phone Cl -j U
'T•i ` r) ` `� l7 Lil .�'n �Zca �" �f) r _�Ci 7••OUI
Contractor J Address
y./State Zip Phone
Contractor City of Ft. Collins Sales Tax r "'-`
c ea,.=znumdersrVquved by ar conmeetom Are you paying with Your trust account? Yes L1 No
is this a residential or commercial projer? 'Residential 0 Commerdai
it residential, is it: Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
0 .Multifamily (apaMerit) ❑ Garage
if commercial, is it: Cl Bank ❑ Bar ❑ Church G Hotei/Motel ❑ Medical ofnce 0 OfSce ❑ Retail
❑ Restaurant n Other (explain)
is this buiiding 50 years of age or more? D Yes ❑ No ffyes, you mayneed to contact Mstoricpreservation
If thls is for a demolition permit, wha_ year was the building constructed? __.
ff,micr ,to I975 yvu will need an asbes.'os assessmont to subrnit with this aaph ation.
of work
r-•umtfd:�, ky
" U lawn sprinkler/baciv7ow preventer, must fist licensed plumber. if first-time A/C, must list licensed elpmGan,
subcontractors: ust tie company. name or City of Ft Collins 1.%cense r
Plumber ;sechanical - Roofer .� 5q ocher
i fiereby acknowledge that I have read this application and state that the above information is complete and correct, I agree
0:3,mpiy kNith 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 Issued.
Applicant: --- Signature ?rfnt lame:__ T 7 u (y2 it'),
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