HomeMy WebLinkAbout1026 Pinnacle Pl - Applications/Reroof - 10/04/2011Orty of Planminlgr DeVWOP heft & Trann
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�,�}261 N. C:ollepe Ave P.C). Box 560
�Cot-bonsrort Collins, co BQ524
Phone 970-416-2740 Fax 224-5134
OVER-THE-COUNTER PERMITS ONLY
This application is 4o be used 6o apply for the frallowing perQsUfr only (check all that apply). O Air Concfitianine
❑ Demolition (Interior non-structural) ❑ Elect-ical Alteration (not sanriae change) D Gas Lighter D Gas Loq
D Heating Unit D Lavvn 5orinkler D Mobile Home raplacement C P.00fing El Sewer Line C Photo -Voltaic
❑ Ventilation ❑ Water Heater ❑Water Line ❑ VOood/Peliet Stove (must be EPA certified, provide make, modal and
manufacturer).
Complete all applicable information on the amplicatiori, IneeoMplia* aapfiaatbons wall not be accepted.
AppliCation ! C) e2-0
Dateuse only L--;14 L:(--�\
Sob Site Address (raouir&) Value Of C0M3trud±i0p (labor, materials, croft)
Property Owner Name Address City/5tam up Phone
. . .
Applicant Name Address
-JP Phone
Contractor`
Address Gty/State Z,p Phone
Cont acts; Gty of FL Collins Sales Tax w Are you paying taxis here or by report? ❑ Here
Sales � numbe- t- rznulrad a# =t a� � P epOf
b1' Are you paytng with your trust acwunt? D Yes D No
Is this a residential or cammerclal project? Residential ❑ Commercial
I," residential, Is it; I] Single Family Detached ❑ Condo/tvwnhome (single famlly attached) D Duplex
❑ Multifamily (apartment) ❑ Garage
If commerclal, is It: ❑ Bank ❑ Bar I] Church ❑ Hotelftyh_I D Medical c�ce ❑ Ofice ❑Retail
❑ Restaurant El (explain)
Is tints building 5o years of age or more? ❑ yes ❑ No !i= yes, you may to con li/sroric Pieser vsdon
If dils Is for a demolition permit, what year was the buliding constructed? _
Ifprior Lb 1 STS, )rvu wrLl need ar, ashes�s assess ,Went b submit H1,1J7 t7is app/ication.
Description of work
*If lawn sprinkler/bac tow preverrter, must fist licensed plumber. Ir' first-time A/C, must list licensed alectrican.
Subcontractors; List 5c- rom03ny,-7ame ol• CrTy or Ft Ce/lies licer,� fi
Electrridan Plumbe
MednanicEI pDc. er Oth21
I hereby acknowledge that I have read this application and state that the above InfOrrnation is complete and correct. I agree to
comply with all requirements Contained herein and city ordinances Bind state lav,s regulating buildina construction. `i know that a
permit Es not valid until it has been paid and issued. J
Applicant:
print Name:--\f.Y-QLd�2C"jC�]`Signature �- \Iu