HomeMy WebLinkAbout2026 Lookout Ln - Applications/Reroof - 09/26/2011SEP/26/2011/MON 1.1:43 AM
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City. of
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P. 006
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Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Coln, CO sm4
Phone 97G 416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This appik anion is to beused to apply for the following permits only (check all that apply). D Air Conditioning
0 Demolition (Interfor nonstructural) ❑ Elec hicat Alteration (not service change) 0 Gas Lighter E3 Gas log
❑ Heating Unit 0 Lawn Sprinkler 0 Mobile Nome replacement 19 Roofing 13 Sewerline 0 Photo voltaic
CI Ventilation 0 Water Heater ❑ Water Line 0 Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable Information on the application. Incomplete applications will not be accepted.
i c��. Application # c Q� �2b�\
For cvfflc & L de only
Job Site Address (f eq)
Value of Construction (labor, materials, profit)
Property Owner Name Address
city/State -,Zip
phone Ghp-
Apprmad Name Address
GtyAtate Zip
Phone
Contractor Address
CRY/State zip ._ -Phone
50?5
..-.
Contractor City of Pt. Collins Sales Tax
Are you paying taxes here or by report? X Here
0 Report
sales raxnueertsrequdbyai/mna�
Are you paying with your trust account'? ❑ Yes
17 No
Is this a reddenti- or camrneraal project? WResidential 13 Commercial
If residential, is it: 14 Single Family Detached 0 Condo/townhome (single f milly attached) t7 Duplex
0 Multifamily (apartment) 0 Garage
If commercial; Is it: 13 Bank ❑ Bar 1 Church ElHotel/Motel 17 Medical office 0 Office_ 0 Retail
13 Restaurant ❑ Other (explain)
Is this building 90 years of age or more? C Yes ❑ No If yes, you nW need to mntad Htsfiric Ptas&vanivn
If this is for a demordion perenik what year was the building tonstrlud eo
Ifprior 101905 yr u W071Wed8.1 asks aWCW7AWtis submvt ►ski this aop cam
.1 1 i • i.
*If lawn spr Udder/baddiow► Preventer, must W rro r*W pitanber. If Past -time A/C� must list licensed electrician.
Subwntraccbmw. Listt6eam;mmyfxear4::lyofRcollmsllwm t
Sect n= plumber *deana Roofer,C-Jg:M&_ , other
I ha&j acknowledge that I Piave read this application and state that the above information is osmplete and correct I agree to
comply with all requirements contained herein and dty or&a, zees and state)aws regulating building construction. I know that a
permlt is not valid until it has been paid and issued.
Appficant: A,j
PJ iAt HamG;M,k,,F - SEt e W 1 i _ Signature - Date C&Le tW