HomeMy WebLinkAbout214 Jackson Ave - Applications/Reroof - 04/29/2014plamdn& DRaelop uent & 7iansPol
Cky, Off 281 N. College Ave P.O. Box 580
C
i"6 f Codins Fart Coffins, CO 80524
ihhahe 970-416-2740 Fax 724.6134 � � � 2.3y • � /
OVER-THE-COUNTER PERMITS ONLY
This appllation is to be used to apply for the {allotting Wmft only (dtedt all that apply). 0 Air Conditioning
❑ Demolition (interior non-atru� 0 Efac4W Alteration (trot sw46e dMV) ❑ Gas tighter ❑ C,as t og
0 Hearing Unit 0 Lawn Sp mMar 0 Mobile Home replacement If Roofing 0 Sewer titre 0 Photovolteio
❑ Ventilation D Water Heater ❑ Watar Line 0 Wood/Met Stove (must be EPA oertified, provide matte, model and
hr® not be accepted.
Complete an applicable information on e SPPk0 w- InoompAate /
Applica # Date
]al, Sftp Address (i qF&WJ��
Vah, of cMan!cq_ _(for• • Pratt)`� �' �J
5-700
Owner Name Address
aLY/stwe ZIP
-
Appticard lam Address
aw/State ZIP Pharr
Contractor Address
1 CitY/State ZP Phone
1
Contractor City of R. coffins tax
you poOV taxes here or by repMV
Afire you paying with your t ado o0 Yess
Is this a residerdial or aagm erdal project? OfteddenUal 0 Corm erdel
If residential, is it; ErSingle Family oedhed 17 conao/to Wme (drgle fan* ) ❑
Duplex
0 mWdf W (apartment) 0 Garage
If mmmadaf, is it 0 Bards O Bar 0 Chhmdh O Hotel/Motel O Medal office 0 Office 0 Retell
0 Restaurant 0 O:p (egd�m)
IS this btrdhfirg ti;0 of affa or rare? f Yes C] No D°Ye+. l� n�Yneed to aovd /lLstaefic PYe�rvovr
If dit is for a demolition permit, vdrat Year was the buMM eonstructedt
Ifprkrin, 1975NwwMneed anades s azeswxW ta,PAW&MMb*4o A2fi M
of
d—
V lawn sp Wda%6aditM , marst list licerred Ownber. If first-time W mutest list 6ceded ddam
pbmjff r Roafa Rat Olha
I hereby adaawledge that I trove read this appklam arid shte that the above bdarmatah is complete and cared I agree to
pmtuR complywithallreq*ementscurab
id ItieAil hashes beer paid an mdhha Kw and state � l regulaft bu ft cmvb rdtoa I'mow brat a
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