HomeMy WebLinkAbout3018 Ninebark Dr - Applications/Reroof - 10/06/2011Oct 06 2011 7:19AM HP LRSERJET FAX
p.15
crt°C
OI �' Planning, peen, & Trans
1, �S 281 N. College Ave P,Q, BOX 580 Portadon
Fort CoRII Co 80524
Phone 470-416.2740 Fax 224-6134
QVS�`�E-COUNTER PERMIT
This application IS to S ONLY
❑ Demolition (Interior non-structural) ur ash' for the foliowin
O Hasdng Unh ❑Lawn mural) Efeccrlcal AReratlogn only (Check all that apply).
Sprinkler ❑Mobile Flame re change) p Gas Lighter Air es Log
❑ Ventilation ❑ Water Heater ❑ W Placement �oofin 9 O Los
m aUnBr), ater Une O Wood/pellet Stove(mustg D Sewer Line 0 photo.valtwa
Compleb all EPA�oertyNed, Provide make, model and
aAPuoable Inforrnatlon on the 400110ation. Incomplete aPplioatlons will not be accepted.
Applkatlon # . l k o L
farm rise &* Date_.JOY
�j c
Job site Address (d� `• W `�
Value of Construction (labor, mabxlalg
$ , ProAt)
0
Property owner Name
Address QtY/Sbte
N � Zip Phone
APPllcant Name W9 �Rq Address City/State
Zip Phone
Contractor Lic2 24l Address
City/State 21P Phone
ConCity of Ft Collins Sales Tax # NN
tracoor
Swe ax MMINrip &Vawosucafty Are you Paying taxes here or by report? IB Here ❑ Report
( Are you Paying with your trust account? ®'Yes OL No
Is this s residential or corr�m al Pr'oject7 Residential C1 Commercial
If residential, Is It: W-Single Family Detached p Condo17 Multifamily (apartment) n°ti"nhome (single family attached) ❑ Duplex
If commercial, is It t7 Bank O gar � Q gage
Church 0 Hotel/Mote! ❑ Medltal Office O Office 4 Retail
O Meant d Other (expiaq,) Is this buliding 50 years 014pa or mare? O yes t No tr If this afar a demotltlorr perrnit, what year was the building oonstlu�teRd7 need to
Cw�~'MOk�B1I
IfPntar10197s,, yvu w,ry//seed an ° S to lding It nsbmth Dbtr
Descrlptlon of work
If f
Suboonb'actora: L& the irst-time A/C, must list licensed electrlaan.
R7 IrY ne/>r6 or city aril' Lowns lkwo°
�ecMda Ph+rhber
McGfurreat ��_ Roofer `��� paler
I hereby adotowledge that 1 have read this application and state that the a
comply with all requimmera Contained herein and city a dlnentee ands bovq information Is complete and mmect. I agree to
Permit is not valid until it has been paid and Issued, laws regulating building construction. = know that a
Applicants
Print Name: Signature
Date jv
w.Ml.� • r `dRENIIIY,. . .i.Y.r. r . .