HomeMy WebLinkAbout545 Kim Dr - Applications/Reroof - 09/13/2011Sep 13 2011 8:128M HP LASERJET FRX
p.3
nwan
'""It M �+"Morlt arm
261 N. t7onapa Ave P.O. ilex SM
Fort Colglle, CD t�4
Phone 970-416-Z740 Frrx 224.6134
•TME-COUNTER PERMrM ONLY l s13
rho aaakntlon 1. oo tt. u.aa to apply for the lonowlrp H•rtrrt.
CI Dsmotwan (InOnlor non- mil► %hook all that apply. O Alt CondltlonkV
❑ Headnp Unit O Lawn �Ider O M RIMeMM Allemilon (rot oharr,)• 10111 lJpftter 17 Gtas
marina 4w O Wate►"8W* Heater Q Weser Lb Horne O WoodlPelrr rwmng O 8swar Una C] Photo-,h,
�"°�' b'lore (must be EPA CGM@d, provide make, made( and
C° a �rnraHon on the applleatlan. lnaano�.
ApplialUM # 0 (o �Q v apo86021nna will not be acoaptsd.
Oahe.
Job . — ffinmrs (ra0~
Property Owner Name
Name
ca 1tradw
Val" of Coeetruefta pabar, maboftla, pa"
city/'.;fate Lp Phone
G►Y/State aP Phone
ctar
5City
till U Salmi
RIwQ * v 1 by r"ort�' ro L] $Gw?(
a►Fsaw•B Are You Ps�rq taxes here pr
Are you pay" with your trust amount? RTel; Gk No
Idc #24 Vr Addrm
Is tt r�dentlal Motwal or I ennal p Carrwr�ert w
1111110 FIS"MY 08tod+ed . O Connh do/0owome (eagle ram
If omI 13 MMftmlly (aperonent) 13 Gerag. IN attached) t] Duplex
Is O Bank C] tNn . G Church 17 Hotal/Motel - 0 Medical *MM 13 OfBoe O:R®an
Is ehta bu 0 R�Urant E3 Other (�m)
" Oft Is ��Mw�t toe Or moray O Yas O No llr ytav nary raced to c flarctM<:�ntr >taabn
l�A�+fvM 197 Yex+irob'i what year was the buk*v ransp�?
abasws Aftesmwto suhftt w►I>ri M& ilmowa,
of
*1f bwn e!>ANder/baelQlow prevanper, moat 11st fterwed plumber. It IPr t ame lye, must U. Utenepd W.W.
Subcontretbaer LdtL�ia etaripa►,y,�„M ar Oq• ofit aWAI r Atww s
9 qumbr
Roo* � Others._
t� ad *"Mdpe UM 1 nave nod this appaCoMn and serfs that the above IMomranan wo o9 rarOt aantnlrled herein .Or d dty orMlaws rs IC I arm nanm and state lapub ng bunding cwwhct n. L k"M thoat a
penult le not "Ud =0 It has been Pald and Iaeued.
APAllosnb
Print No sonatnro
oma V 131 -! J
.. � .. _..._.. .i. .. .