HomeMy WebLinkAbout1351 Forrestal Dr - Applications/Reroof - 10/28/2011City,of �� mart St 1nar�tiem
FoCollins `?l� rat Ave�` �°
Phone 970-416-2740 Fax 224-6I34 b
OVER-THECOUNTER PERMrM ONLY
This applieaton is to be used to apply for the fo0owbg or ft (dvedc a0 flat apply). ❑ Air Conditioning
❑ Derr"Morn (anterior nor"ttidural) ❑ Electrical Alteration (rot dhange) El Gas Lighter ❑ Gas Los
ting ❑ Heaunit ❑ Lawn Sprinkler ❑ Mobile e Hamrep rt Reofms ❑ Sewer Line ❑ Phokw4oftalc
❑ Ventilation O Water Heater O Water Line ❑ WoodlPe d She (must be EPA certified, provide make, model and
manufacturer). ``
Complete all applicable informabon on the a pplicatimL hwornplete > be accepted.
Application # Date L l
For /se aMy
30b She Address ( ��
Vakee
3� of
it (fir, rr tom)
cc)i
Property Owner Name Address
9 G O V V
Appli aunt Address
�/�.��
Clt /State
-S
Tip Phan_
�.< 030
Co 90al
Contractor Address
1 City/slal a
zip Pion
Contractor City of Ft: Colfax Tax #
&d s5 tv �eerrrmesbranccrma�►s
Are you pafV*V taxes here or by report? flit Here ❑ Report
Are you payM with yrxr trust account? ❑ Yes t�
Is this a residential or m3mvrcial project? ff Residential ❑ Commercial
If residential, is it: Q Bungle Family Deta and O Confthowniame (ale family anadhed) ❑ Wpkx
❑ M (apartment) ❑ GwW
If commeadal, is it: ❑ Bank ❑ Bar ❑ Chtudr ❑ HoteJ/Nlotel ❑ Mfg affhoe ❑ Offioe ❑ Retail
❑ ResWura t ❑ Other (explain)
Is this buelding 50 years of age or more? O Yes O No Byes, pw may need to mrda&M131cP)eserhs &w
If this 6 for a demo0lmn permt, what year was the budd'mg owsbucted?
Bpwtn1975,yvuwfflneedanasbe M7s tomlbrnnTmfhb' sapp//obiaot
Desc ipbon of work
*If L3 m sprirdder/baddlow preVenter, must fist 6cased pdanber If first-time A/C, want Ist libersed edectrkian.
Lstd* cwtaaVnww crCRyaiRCa@fiesBh0
Bemxdan Pqmba Macim al Roars R-. Al J t Other
I hereby acknowledge that I have read the appIratian and slate that the above bdomraW is err -I I e and correct I agree b
comply with all requirem7xts mxtairW herein and city erdmanees and state laws replating bxaldmg wnstnxi I know that a
pa unit is not valid until it has been paid and iashhed
�U