HomeMy WebLinkAbout715 Keenesburg Ct - Applications/Reroof - 08/30/2011Aug 30 2011 5:50AM HP LASERJET FAX
P.5
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`Collins 281 N Ant�nt 8 Trany�oMilan
Fort Collins, CO
� Ave ve P.O. Box 5B0
B0
Phone 970.416 �4
lax 224-6134
OVER-THE-COUNTER pERMITg ONLY
Thin Applkatlon k to he 43�
CJ OemoNeon I ue�d in aPPh/ for the following pamite Only V
(nterlor no"ructur Y (ohsok all that
❑ Heath Unit C] M ❑ EIlis oal Alteration (not s ofienDa) O G sUgtftr�C Ip L,
O Lawn Sprinkler O MobIN Home replacm•nt
C3 Vandia�n 13 Water Neste► O Water Ltne ❑ yy Qff"Wing t7 Sewer Line O Photo-voltelc
manufacturer). Wood/pellet
Stove (must be EPA cer"ed, Provide make, model and
Coniplela ap applloable infonation on the ravplialition, Ina
ApP1103don 70t p apolieatbn• win not be
aW /o�L 'yg Dane
fob !flee Address (rep~) -
ProP" Owner Name
Applicant Name
Contractor
Value of CO ObiaCtlor (I&Wr, metarials, profit)
$ --I C. / -% y C-
Address GH/Stato
- 11 _ I _ zip
Address - Uh,/state
np Phone
Uc Address city/state
i t .�r, r c � � n,, . n .., 11 �P Phone
Contractor City of Ft Colllrls Sales Tax #
Are you Paying taxes here or �" .en.
by report? t�9 are O Report
Are You PaYinq with Your mist a0ount9 9P T106 &II No
Is this a residential or air a pro�j Residential [7 ComMerdal
If residential, Is it: H SIn9k Family Detached 13 Condo/W"h0MeI (single family attached) 13
13 MuitffamllY (aparartent) 13Garage Duplex
If eomrn"I, Is It: d Bank D Bar ❑ Church 0 MoteVMobal ❑ Medical oflfoe O OftToe t7 Befall
Is this bW C7 Restaurant 13 Other (explain)
If this Is for ra amiltion ION Of "M or morel O Yes t7 No l/y yq� yr dtoCrantadH/stnnrcP�e
APA*r & 1975 Wu ►vl7/ ft what Y was the building OonstrirrtQy�
aO&Awent to snbm/t milt! aM&+tAayrat xi
Description of
-1 lawn s M'W/bKftw Preventer� must Ilst licensed plumt,er. I( fl
Suboontramm'r /.<At lyre n�nb N� must list Ik ensed eleMctan.
�nyAmms cr L71y Of CaMns &-em C t
Pump Pled nice!
ttoor� �� Ottfer
I hereby adQ *wkdpe that I have read this
oomPiy with all nqutrsnrerrer con0elned herein are dty o�rddin no�ea art lee lydbnnaticn Is c oniplete and aareet. r agree to
permit b not Valid Until it has swan paid and issued. r>•gubtlng building cansbu on. 1t know that a
Applicants
Print Na•ra:Emay 6n Signature _ , J/1 eaaLO�
l .. —. Bata �
uA.