HomeMy WebLinkAbout1761 Glenwood Dr - Applications/Reroof - 11/25/2013� ' City. of �Insr Dewelopmu nt
w F� t, I �1 7�RSpOrtartlOn
,y yr, . ; =rN- G�Cje Ave p.o. Box SW
ti-
Fort Gofbns, OD 805241
_..r^ Phone 970-416-2740 Fax 224-6134
OVER-TH&COUNTER PERM 3a.13
ITS ONLY
This application is to be used to apply for the following Permits only (check all thtrt apply). ❑ Air Conditioning
❑ Demolition (interior non-sh =Wn3Q ❑ Electrical Alteration (not service change) 13 Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement XRoormra ❑Sewer n aFrd., yr C
'vea�waw�f u vrrarer Hearer Li Water line ❑ Waod/Peltet Stove (must be EPA certified, provide make. model and
manufacturer).
Complete all applicable Information on the application. Incomplete opplicatiorre Trill not be accepted.
Application # 15[30 Vi bL I
,smote LW oft/,
lob Site Address (wLoed)
Property owner flame
� oo"
Applicant Name
eV\.woocl
Address
1 d S 0".Vy\ -Q,
Date It-e15-1-3
Value of Constnr ban (labor, materials, profit)
-0O
be zip Phone
R n - Ljej--� q -3S
MY/State zip . Phone
f or Address _ aty/swe 7p Phone
Fhl Roofing Inc. (R-400) 1629 South Lemay Avenue Ft. Collins, Co 80525 970-221-1388
Coniractrx Cr1Y of R Collins Sales Taos # Are You pWng taxes here or by reports G Here ❑ Report Sales r?xaraabe,rfsre ur edbyadarmaC&M Are you paying with Your trust ai[icurtt2 ❑Yes 1 No18596
Is this a real cr commercial woject? OResidentiat ❑ Camrnerciai
If residential, is iCPrSingle Family Deladred ❑ C0nd0J6owr1fi0me (single family. anBdx%Q ❑ Duplex
Multifamily (apartment) ❑ Garage
If commercial, is it: D Bank ❑ Bar ❑ Church ❑ Hobe motW ❑ Medrcal onke E3 Ofrxm 0 Retail
O Pestaurant ❑ Other (eglain)
Is tins building so years of age or more? o Yes ❑ No rfye!� youmayrAwdto cnntact,r
If this is for a demolition permit, what year was the building oorvMuted?
Ifpnbr to 197S, you taw'///lead an a st estma2sgo"jerttAD submit wtdi btw appk Btbrx
0
*If lawn sprhddw/baddlow pteventer, must list i'ioensed Plumiw if fast -time A/C, must Nst licensed electrician.
Subaoritrarbor c L8t the con*kwyn3aw or01yodR Cbrp.jbwm #
Pqm bw Roofer Other
V111"t
I hereby admowledge that I have read this appikatim and state that the above Irdbmradon is conpleDe and corral: i agree to
Panoply with n an valid wire k haraa eel herein and ssu ordIrmwPs and state taws regulating b Adingl eorhtr tlon. I know that a
permit is not valid rortil it t� been paid and issued:
iName: Shinature Deft
l'd 9Z99-lZZ-OL6-t -out 6w;ooy W:� d170; 60 £6 9Z AoN