HomeMy WebLinkAbout561 Yuma Ct - Applications/Reroof - 09/26/2011,a; {_P9,/26/2011 04:12 9703539774,
City of
Fort Colons
INDEPEDENT ROOFING I PAGE 02
Planning, Development &Transportation
281 N. College Ave P.O. Box 586
Fort Collirr5, CO 90524
Phone 9713-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). p Air Conditioning_
❑ Demolition (interior non-structural) 0 Electrical Alteration (not service change) tD Gas lighter 0 Gas Log
Heating Unit C1 Lawn Sprinkler t7 Mobile Home replacement XRoofing 0 SewerUne • 0 Photo -voltaic
0 Veriblation Q Water Heater D Water fine O Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the appliestion. Incomplete appli0 tons l not be accepted.
Application # 0 � i _1- 5 'Date q/a IP/ ! I
A rofde cue onh ..
39b bite Address !required) Value of Construction pibor, materlals, profit,
• # sus,
Property Owner Name Address City/State ZIP (�o Phone
` ,Q.am.c Sv. SaS Irf 70 7
Applicant Mame Address Cfty/State zip Phone
Same
Contractor Lie *R2 9 4 Address city/State Tip Phone
i Independent. Roofing Inc.. 405 22nd St_, Greeley, CO 80631 970=353-1389
Contractor City of Ft Collins Sales Tax # Are you paying taxes here or by repo . D Here X3 Report
sawtarnr�ffesregrdredbyatica►,tracmrs Are you paying with your trrts ust account? Sl Yes 0 No
Is taus a nesiderdal or.commercial project? M Reslderftl ❑ Commercial -
If residential, is M O Single Family Detached 00 Cando/townhome (single family attached) Duplex
ID Multifamily (apartnre:nt) p Garage
lFcommecial, Is it O Bank 0 Par V Church ❑ Hotel/Motel ❑ Medical office 0 OfF= D Retall
❑ Restiurant Cl Other (explain)
Is this building SO years of age or more? Q Yes A No 11Fyes you may need tta c�a►ri�d Hc�nric Pr>es'rva�on
If thus is for a dermordion pertnW, what year was the building constructed?.;
�pnfar h� 19TS, Jrorr wl//neod an aegis a�r�er�t tb suom� rv}i"fi this appGcabS�
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1 1 L - r= ICI - _�.• •i - �r O ■- -1• �.11
I hereby acknowledge that I have read this applicatfon and state that the above inf lormation is complete and correct. i agree to
;Pmply*with 0 regoiremeres contained hereh-wd n"iy.-ordnanaes arid irate lam regutadng buildingsorrsbx= ion; 1-know. that a
pwizif i6 not valid unsint has been pa;d and bwed.
Apprimint —�-
Print Name: 11-
t•�tr --. SignatureZ4Date K „ 1