HomeMy WebLinkAbout633 Roma Valley Dr - Miscellaneous - 05/31/2001 (2)MAR-20-2001 TUE 11:45 AM FO BUILDING AND ZONING - FAX N0, 9702246134 R 02
ZFortollins Residentlnl Energy codeATION piSCLOSURE FORM
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Job aiddroas:
General contractor;
insulation contractor,
the building 4 zoning dept. of
oommunfty Planning and Envkanmental Services
2*1 N. Ockic Ave., P.O. Boot t1enJ Fro, Cow CO egg=
Vafoa: FM 221 Ift FAX- gip 224 6194
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This disclosure,N"1' Y. 1 MIV VM\ Y• A'. :: :''L:'.JJ. :'•: L'.... ....... ..
form is to be signed by the Insulation contractor or representative or the yanerel contractor.
pieaae type or print, vxoept for the slgnsture Complete the informaflon In the n„a7„a .auk ...., nw...;„ a«;M
If components vary, make muidpie entries to describe them• appropriate epom Provided.
One copy of this form must be provided to the Building and Zoning Department p
One copy of this form must be made available to the crigihal home buyer oor to the C.O.
Plat or vwltwt neilinps
with Aulue above
Celllnps with a� nclvmw
rater avitiss
Prams walls and rintlband
joists - to exterlor
Frsma walls— an— d r— � hd
Mato - to atuc, verapa
game floor • Cantilever
Frame floor • ever games or
crawl space
Slab-o"rade (0-12'9
trawl space walls
lleeemeht wells
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fife above Ast.tf inst"on was in+gged in ins building a1 the above 5loeedons (n' tooMamar,co rrieh tharyH'J iimants5el�ur
Fqt Co111ns Raalder,dal 6nWW Code, Wid that It was humped lh aaezrdanca wkh the •lnsulsdoOukhrNnse` Published by the Oigr of Fort C of
Person Certifying �cp; yj p i , r„ r•y1 . ! 1 _
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