HomeMy WebLinkAbout537 Yuma Ct - Applications/Reroof - 09/26/2011i
09/26/2011 04:.12 $703539774 INDEPEDENT ROOFING I PAGE 06
Gty Off , Planning, Development: & Transpor at ion
Fort Chins Fort Coll281 N.liions00 60524' -ege Ave Box 580
Phone 970-416-2-740 Fax 2-24-6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply'for the following permits only (check An that apply). D Air Conditioning
❑ Demolition (interior non-stwcturan D Electrical Alteration (not service change) 17 Gas Lighter D Gas Log
0 Heating Unit --0 Lawn Sprinkler 4 Mobile Home replacement XRoofing Q,Sewer Line. C] Photo -voltaic
D Ventilation O Water Heater O Water Line O Wood(Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application_ Incomplete appli lor1S wl not be accepted.
Application # I I 0-11 Date q 5o
For ofl9ae tw only.. _
39b Site Address (raquned) Value of Construction (labor, materials, profit)
573'7 C. 33 sc�s.
Owner Na e . Address City/State • • Zip - . Phone
Applicant Name Address ci
tY/StMB _ Zip Phone
Same
Contractor Uc.#R294 Address City/State 71P Phone
Independent Roofing Inc.. 405 22nd St. , Greeley, CO 80631 970=3.53--1389
Contractor City of Ft Collins Sales Tax # Are you paying taxes here or by report? D Here] Report
s tesraxnymberisregreb�adbraara�naa�ws are you Paying with your tust account? X1 Yes O No
Is this a residential or.commercial• project? ® Residential ❑ Commercial
If residential, is It: ❑ Single Family DeUd-wed la Condo/tawnhome (single family attached) ® Duplex
O Mul ThIly (apartment) ❑ Garage .
If commercial, is It Q Bank ❑ gar p church Q How/mew - ❑ Medical office 13 Office 0 petal
Q Restaurant O Other (explain)
Is this building 50 years of age or rnore? C3 Yes . ,& No If yit you may need to a-Dn&d-t yAS6* Prrmnratron
If tfris is fora deniol"rtion penfnit, what year was the building constructed?
Ifprbr tO 197.f yw wff/need an asbestnsazmwnentm submit mi* this apP&W
Desorption of work
,%,r,a 1 1-e4__
*)% tartim sprrnlder%badcflpuv-pteventer, most list licensed plmbw.
Subeontrac, Lit Zye mmpany name or a y ofR r oft &MW g
A/r, fh&t list licensed electrician..
dumber MEd0rnail
_ - Otl'ies•
J e 30710mauge that I have read this aWknfim and sbbe that the above information is CDr ham. and correct. I � to
s w nera contained herein and lily-ord1nances and state laws regulating building -consbuctiorL 1 •imow. that a
permit is not valid until'it has been paid and
Appr'uant:
Print Nana: I I r.Y - r• v+-,eor
D2ft 61-a -11