HomeMy WebLinkAbout619 Flagler Rd - Applications/Reroof - 09/12/2011Sep 12 2011 11:13AM HP LRSERJET FAX
p. 27
Planning,, Oaralo igient & hansportrestlon
261 N. College Ave P.O. Box 590
Fort CWllns, Co 80524
Phone 970-416-2740 Fax 224.6134
-COUNTER PERMITS ONLY �5d
This applkat hm I@ to ba used°� ap�y for the folbwln
D Demon 011 (IrMarfor non.stnloturel) O Electrical 1lowli i ( Pwm� Only ((shook all that apply). O Air Conditioning
O Beating Unft O lawn Sprinkler O Mobile Home rOOR gs) C] Oft Ughtsr ❑ Gas I�
❑ VOnnufactursl8tim water Heater ❑Water Line 17 Wood/Pel�lst Stove mum tine PA cwrtifl d provideema a model and
vobk
marxifacturea9.
Complsb all spell la Informatlon on the application. Incomplsb eppiloa.. tle+. will not be accepted.
Application # 1)C � %�-9! Date , Ll_ ` 4 A
fcr h FDM UJU tiny?
Job Site Adrdnlsa (n r9d) Value of OonadM trun (labor, meee elk pro"
TPro1perty Owner Name Address
�/�m1 ZIP Phone
1 O r
Applicant Name AddYess aty/Stabe
ZJP Phone
Contractor UC #2(1 r Address city/State
ni i r i ZIP Phone
Contractor City of Pt. Collins Sales Tax #
-qAW atr
canlrictws
Are You Paying taxes here or by report? ® re O Report
Are you paying with your trust account? MA Gk No
Is this a r+esld-Imili--- I or erdal PMjer�? entlal O Cmhmerdel
If residential, is It: Single Family Detached O Condo/townhorne (single famny attached) a Duplex
O Multifamny (aparbnent) 13 Garage
If oommendal, Is It: C] Bank C7 tier C] church Q Hotel/Motd ❑ Medical oflloe D'office C) Recall
13 PAstaurant ' . C] Other (explain)
Is this building SO team at ape or more? Oyes ONO Ryas. yav rrrayriaad to cw&et Mao** p,Wry alw
If this Is fbr a d emolithm permit, what year was the building aonsinxted?
1fjvdw 10 IVS,, you w/# need an esbesWs asSess7rent to at/b 7W MW b* 4010kafta
r,
*If lawn sprinklr/beddiow preventer, must list licensed plumber. If first-time Ajc; must list licensed el cbWan.
Subconindlim, Cfct 1be cv►rpoeny mama or O y of Ft' C-OWns ftmw f
Eloarl an Plumbs HedwgcaL. Roder
I hereby ad0ewledge tint I have read this applkoUon and state that tM above infbmwtton Is completat and correct I agree to
comply with all Mquken wit ca I Ined he" and city ordlnamcm and state taws regulating building construction. I know that a
permit Is not wOd anla nu
K has been paid and Ie&
Applicant:
Pratt Ram: