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HomeMy WebLinkAbout3839 Lochside Ln - Applications/Reroof - 07/17/201307/16/2013 14:32 19702241211 c ROCKY MTN ROOFERS PAGE 01/01 planning. Pwd"rr * & 7ransportalion 1r. r 1!� G+ ins i inns, w „ F Phone 97t1�16-24 2740 Fax 224-6134. Mono 2740 i OVER—TjiE-COUNTER PERMITS ONLY This application is to be used Iwo • Demolition (interior non-struchna} ly for the following permite only (check all that apply) © Air Conditioning 0 Electrical Alteration (not service change) 0 Gas lighter 0 Gas Log CI Heating Unit El Lawn Sprinkler Mobile Home replaeemerd Aloofing 0 Sewer line ❑ Photo -voltaic CI ventilation 0 Water Hester ❑ r Line 0 Wood(Pellet Stove (must be EPA certffied, provide make, model and manufacturer). complete all ap le nform an the application. Ine mplete applications will not be accepted. l�,pplitation Date l=nr attire lisle only Job Site Address <rawhedj ? Value of Cocn4lrucdon (tabor, materials, profit) 3'� 3 C a �,�r'00 Gam �3..0 p ... arty Cra�nec P1arne Address City/S'ti to Zip Phone t 6 Applicant Name I Address city/State Zip Phone Contractor tic # - 1 95 Address Cill/`tate Zip Phone pled Rc CX-A6 W�Nzx' ri i . Li r, c z� ZZL Z-00 '� Contractor City of Ft. Collins Sales x # LA i ':tn(.p Are you paying taxes here or by report? 0 Here Report Are you paying with your trust aacount? J6 Yes ❑ No .,z� &w„ mbar s,aqi&ad aye i i ? 15Wesldendal C1 Comrrerdal Detached ❑ Condo/townhorne (single ramify anached) Cl Dupli x Is this a residential or commercial p If residential, la It: Single Farm Multifamily ( If commercial, is Et: 13 Bank © Sao, rtrnent) O Garage Church 133 Hotel/Motel Q Medical office 13 office ❑ Retail ❑ Restaurant ; 0 Odd (explain) Is this building S"O y of aF ? CI Yesif this is for a demolition peryear was ft building constructed? DPpror to z97s, yw wH/ need a 7X*nt"tn submit with coifs applfcandn. . Description of work 4eL oo o r+r �[ iPe w ci i 4t^'�-�+e_ G0 2N iv vfL *If lawn sprinider/backflaw per, list licensed plumber. If first-time A/C, must list licensed n. ^'� Subcontractors: List the company name or Cty offt C ias license r / r¢ r✓10 NO' i Elecbidan Plumber Medw Roofrs Other I hereby aclmowiedge that I have read this application and state that the above Infrurrmban is complete and correct. I agree to comply with all requir'emertts contained herein and city ordinances and state tangs regulating building construction. I know that a permit is not valid until it has beerfpaid and issued. �lcw 746 , ✓ t mantra: `�' Signaf5tre i7atB —rruS7 Nccou l+