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HomeMy WebLinkAbout637 Blue Mountain Dr - Applications/Reroof - 10/21/2011Oct 21 11 09:05a FM Roofing Inc. 1-970-221-8526 PA Fort Collins Piarm"rng, DeveklIVINNOtatiiiat on 2K N. College -Ave P.O. Box SW Fort CAltM CO 805L4 Phone 970416-2740 Fax 22"04 OVER-THE-COUNTER PERMS ONLY This aWtcaflon is to be used to apply fw the *Mowing perm118 or# (cheuria an tot a!' & 13 Air Corrdi6oning ❑ Oemorftn (mosrior non-structural) © Electrical Albera im (not service change) ❑ Gas Ughtw 0 Gas Log ❑ Heading Und 0 Lawn Sprinkler 0 Moble Home repWment EtRoofing ❑ Sewer Line ❑ Phft-vofteic - rn Ventilation ❑Water Heater 0 Wader Line 0 WoodfpsW Stove (must be EPA certified: provide make, model and rnanuer). complete all applicable. on the appr=don. nppiicatJW # a� �1((� lncgnphd& a ppacedons vAl not be accepted - Data t o -3-1- 11 Sob Sft AMf ees (ra d0 value of Co on (labor, matuials, profit) � 7 Q ICU _ i'� o cc �tttt � �� 4 r $ Properly Owner tame Address City/Slate Zip Phone W72 Name Applicante Pho Address atf/Stabne Cordtracinr tic Address CdY/State zip Phone FM Roofing Inc. R-400 1629 S. Lemay Avenue Ft. Collins, CO 80525 970-221-1388 Contractor City of FL CoBvus Sates Tar * Are you paying In here or by report? ® Here ❑ Report sales a�rnrareberBr+ePuia�bY�aonba�rs 18596 Are you Pay" with your trust aamunt? 0 Yes Ill No Is this a redden f or commercial proled? Mitesiderdial ❑ Comiruerclai ❑ Duploc If ram. is it E LSargle Farrutily DeI:acred ❑ Condo/WWnhome (Sfi91eFdmffY ❑Muftffan*f( ) oGarage if cornrnerdal, is Fe ❑ By* ❑ Bar ❑ Church 0 Hotel ❑ Medical office ❑ Office ❑ Retail Reid ❑ Odw (explain) Is this building 50 yams of age or more? D Yes ONO ffYeSs Y� �Y need a? au►Naid fermi^ P►reGiar/ If this is for a dermo6tion pelt, what Year was the bdAding cortsuud ed? 11`/.oforLD 1975, pw wXneed an a0esWs amemment W R&nt wM dM at V&aWa Description of -work � ih� [ 424 S� ( t t 4lS �0. fI �1e ail TE *If lawn sixadder/6acmm preen tier, must list kersed plumber. If first-time WC; must Ust kmsed ele"d 5ubcontracbor Jan Pbanber. meda*A Roofer Other I hereby admowWge VIA I have read tt» app)katron and state flat the above inCanrd6orr is odnpl�e and onrrst I agree to Comply, wth all n quire� aontaared herein and dy ordinances and state lays regulahm WD&M axml:rucbom I lorovv that a permit is not rrand until a bas been paid and issued_ Applicaft Print Nacre: Signature.l 1-- Data