HomeMy WebLinkAbout5121 Stillwater Creek Dr - Applications/Reroof - 08/26/201108/26/2011 00:36 FAX
la011/02i
`Ay'Colllns
planning, Davelopnmd a Transportation
281 It COOP Ave P.O. Soot 580
Fort Collins, CO BOS24
Phone 970-416.2740 fax 224-61.34
OVER-THE-COUNTER PERMITS ONLY.
'ling appg=Won is to be used to apply for the following pannlls any (oh.ek all that apply). D Air Conditioning
0 Demofton (Irftft'r norrWLwtural) O Electrical Alteration (not service change) 0 Gas Lighter 0 Gas Log
0 Heating Unit 0 Lawn Sprinkler ❑ Moblio Home replacement Roofing D Sewer Line 0 Photo -voltaic
0 Ventilation 0 Water Neater 0 Water Une 0 WoodMallat Stove (must be EPA certMed, provide make mode► and
manutaoturer).
Complete all applicable Jnfonnatlon on the agvll�c UwL hwomplste appllo dime will not be accepted.
App)lcatton #-110 b3 gy `fof+O,S,� Date
A r afike use &dry
]ob gas Addrew (Amp twO
Value of Oonstradlbe Gabor, materials, profit)
512 Cr — I�
$ Opp too
Property owner Name Addresb
GiN/State CCMp Pions 9-TO
31`l - IlD2ty
p.
l.0 c�f�
AppGcarrt Nerve Address
GlY/Stator f-�- Co i) l r, s Zp tV Z4 one
. L;iY
� �e-Ti a5 . ec
Cor&vcWN. UC * Address
Cky/St" V 1-lclUv-6 Zrp K?F—) 71A Phone
Auk l I i
of Gam. Z
Contractor City of Pt d6lRns Sales Tax
Are you paying taruss tare or by raport? A:LHere irrt
Are you paying with your trust account? 0 Yes
noaces
42�
Is this a realdtttlal or commercial pmvW 04esiftM 13 Comme=l
If residential, to It: 13:Single family Detached 1�CondoAmnhome (single family attactred) D Dupim
❑.MuRnndy (opathnent'1 [[]] �+Arage
If commercial, is fo 0: Bank ❑ Bar D Church C7 NaWUMoOd D Madkzl ofike ❑ office O Retail
D Amitsurent CJ Other (CMkin)
Is this butldbv 80 ymni; of age or more? 0 YGa VM0 JFM ym msr tied m mnrscc rLldvx vrguavab ar,
If this is for a damolltlbn pww t, what year was the building WnstrucbeV
gyp . eo 1975, ytw well' need an esbeAw asammfit 0 at&?& WM door alga4t tvL
of v7,1r
�
'r°IP fawn spnnrder/ prevanoae) must pat Reamed plumbvIf first-time NC, must Ilet licenaea elecQw�en.
SYbt)plll�pfti; LK the m//�►!y rldllle � Cl(y prR Cb� fioxa! d
gew.r,�n Plum Oer Medtanim(, Roefr �:..� f1ttta
l rl
n and state that the above Inlbm adcn % wmp� and correct. I a4rae to
1 hereby sckrt aMronaft contained that I have read thole in anddty do naoss aril start lawa regulating building tonvWuodore. Slow VM s
Parma is notit has been Vold and mtued.
pAPPROUM
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