HomeMy WebLinkAbout1532 Painted Desert Ct - Applications/Reroof - 08/30/2011Aug 30 2011 10:48AM HP LRSERJET FAX P.10
� Of
ji1hS Planning,
°i"�281 N. A�nO.UtionP.
Fort Colllns, CD 8p524
%'hone 970.416-2740 Fax 224-6134
OVER-T1�1E.COUNTER PERIIIIITg I�t
❑ hpaR, gOn 1. to be used to apply for the foilowl ONLY
t7nlarbr non•atruchI O EI no "Mlb only (gmck all that
❑ Heating Unit a Lawn Sprinkler ❑ Mobile Ha l Alteration (not aPJJ ❑ Air CondNoning
❑ Ventilation Q Water Mabib Home replacement pry�nge) O Gas Lighter t7 ass LOU
manufacturetj. �at°r ❑Water Line ❑ Wxypellet Stovo m ng D Sewer Line ❑ Photo-vollaic
�mpleb all applicable Info ( be EPA certilled, Provide Malec
n'netion on the apPNoaNan. , model and
ApPlkawn * Inoolnol.e■ appllaationa Will not be ■�
�� � •OciDate
Job Site Addtass (,a9ead�
C+ Valhi o! Cbmm"Won (labor, metamlas, proflq
Property owner Name
Address CItY/Stiebe
IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII—
,r^i�.C1, ZIP Phone
Applicant Name
Address � /ate 0
Ztp Phone
Contractor Lit ,mod
City/state zip Phone
Contiac0or CRY of Ft. Collins Sales Tex # V4 l W
.s�srarnvme•b„q�„poY+®'cW,eacmr: � Yvu paying taxes hero or � �•�63
Are yp Paying our by ►eporV C8 Here C3 Report with
Y trust acoount7 O Yes 1240
Is ftq
If resod Ksl, is It. or omm�ygal Proms Residential O Commerhal
entlei, Is R: OpfM marrlllY Detached (ale faml lY (apartment) D Garage❑Cord N attached) O Duplex
If cornmercK Is It: CJ Bank ❑ Bar ❑ Church D MoteVMotel O Medical office IS thls build so D of , - nt O Other (explain) D OI?tae Retell
I} this Is for aademawn are or morel Q Yes O No lPymg, yqu,�
IfAgW to l97$1ga �gryerI what Year was the building constrt�d7 ri m �vntaa y ,
s xnt to aJJ wary aY 4GWtkaabrlt
�esglptlon Of work r ,..,. !^ ..
*If
Subconbactem Z& /MW Oty of q e Al4 must list IlCensed .1WI
Plumber
Medlirical���• Roofer
I hereby aq°10Nfyd0e lha; I have read this ~�
co""
wnh ell re9wn that I epntair herein Pam tion and state that the ebm Information le
P■n" Is not Vold Mall' tt has been �Y ordinances end stets kwa Complete and mrrecL t
Paid and fssyed. fepulatlnp building construction. I know a
Appilesab
Print Name:�� yj` gyre
Sl
Daft
. PN.