HomeMy WebLinkAbout6312 Constellation Dr - Applications/Reroof - 11/14/20112611.:,11m-14 14:22 Pinnacle Roofing 8772389205 >> 970 224 6134 P 3/3
Planning, Development & Transportation
Cfty Of 281 N. College Ave P.O. Box 5W
F„ out Collins � Collins,-16 �24
Phone hiD 8052 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This application Is to be used to apply for the following permits only (check all that apply). D Air Conditio,ting
CI Demolition (Interior non-structural) 13 Electrical Alteration (not service change) I7 Gas Lighter 0 Gas Log
O Heating Unit ❑ Lawn Sprinkler O Mobile Home repiecement O Roofing a Sewer Line ❑ Photo-VOitaic
O Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable inibill tlon an the application. I"complete applications will not be accepted.
Application # � 111051 Fora.�t� X �: �•�
lllx wemy � I
g3obSftaddress lievhd�edlValue of Constrtic�nlabor, materials, pfw,wner lubame
Address CRy/State TPPhone \
Applicant Name
Address aN/5� �p
Adder Gty/State Zip
Contractor S ^�
Are You Paying taxes here or by report? Isi'1!ie e ❑ i; eport
Contractor City of Ft. Collins;Sales Tax # with Y trust: ❑ yg p IVo
Saks tarrMXtff tsnh0md by ��O/S Are you Paying
is this a residential or ki pry? G(Residential 0 Commercial
If residential, is it, Single Family Detached O ('condo/townhome (single famiy attadred) 0 Duplex
p Mutftrruiy (apartment) ❑ Garage ❑ t>fllce . a Retail
If corrmherpal, is it ❑ Bank ❑liar iJ Church 13 Hotel/MotelO Medl®I ofiiae
El Restaurant Q other (explal9� t+or►
is this building So years of age or more? O Yes Er NO If yes you fWY need mnbd Hzt m* Avsew
if ibis is for a denho6tlen permit, what year was the building constructed?
Ypnorto 1975, you INN Owdanaa C5&540�msment10A&n/t with thlsapplxahm
*If lawn sprinWer/baddlo"v preventer, must K I owned plumber. If first-ane A/C, must list lioen5ed electrician.
Subcontrsttors. lust the canpany na►m Of Oty d ft C} hWN G Vxw't
7trAl1� Roofer other,;
I hereby with
all ledge requil that i have read this aWKadon and state tfiat the above irnomtaoon is owe and correct 1 agr. -eto
compermyit is not vaUd whtli It has been Paid and Issued -
and slate laws regulating bu9ding oxrstrtx�on. I Inhorn' .that e
Applicant'
Applicant' --C �,Il �`�\�� s>yrsw 0 1-�_ - ,�1a _ _ Date
Print name:_ ^