HomeMy WebLinkAbout2625 Mckeag Ct - Applications/Reroof - 01/13/2012Jan 13 2012 7:21AM HP LRSERJET FAX
P.1
C1 of
IPi Collins Planning, C*V°bMn Pn►t a
281 N. College Ave P;O. 8ox�gp porb"on
Fort Collins, CO 80524
Phone 970-416.2740 IF8x 224}6134
OVER.THE-COUNTER PERMITS j# i74 7 This application is to be used � e � NL
D Oemolhlon (tntsrip n apply for th. following Permit# o
O Heating U or"tructural only
(check all that Unit 0 Lawn S ) kj Elactrioal Altome eration (not se�drv'iyA a dtange) ❑ h PPIy). Air CondfNoning
0 Ventilation 0 Water Heeler ❑ WaterLine H(3Wood/P replal m Stove m� L'9hter O Gas Loa
Rtanufaamr). 4 0 Sewer ne 0 hoto-vahic
Compleb all
( EPA cow
i I. provl ie make, model and
appllaablf! 1rftrmatlon on the appliostion. Incomplete applications will net be
Applicatlon #J� S
ure anh, Date t — (3- f Z
Job Site Address (mW,ed)
-
fr?perty Owner Name
Applicant
Contractor
.E .
Address
LIC # RZl l rti�Ad re s
Contractor City at R. Collins Sales Tax #
-%ft bl;sM ar odc ova
At It i
Value of Con"r;;�on labor, m DeHels, PrpAt)
lit
CItv/State
City/State 21p�
Phone
City/State Zipi Phone
J r
Are You payln taxes here or , M ,
Gh No
Are you Paying Cb
with your trust yacco nt7 0 i ese 3 Report
Is this a tial, is it: or ctiptr o"ka s P 7 Residential O Commercial
If residential, Is it: Single Family oebc� O Condo/townhome (single family attached) Q Du lax
O Multtfamlly (apartment) O Garage
If commercial, is ❑ Bank p gar p Church O HoteVMOtOl O Medical office O Office ( Recall
IS this build So C3 R"Murarrt O Other (explain)
If this Is for dsmo11t1on srs of "a or what morel l7 Yes D NO lfypsy ygp,,1ey need to,197S ypy ry f/ r W3s the building conshvcted?
rsest rnerrt [tr s7ibmVit WM MIS spp/kaeian
of work
*If lawn sprinlder/bcldlow prevenber, must Ilst licensed plumber. If first-time A/C, must list I1Censed
Suboent*acton:thtdieCVM; ny1yme0r0?Y0
fRC0
///nsice /
Electrldan_� Plumber
t+tedanieel�_ Roofer_
I henry adawwiedpe that I have read this appikation and state that the above Information is complete
comi rl It nwitot al vOW MOft has been Contained herein and MY ordinances and state laws building cor
paid and Isswd. regulating
Applicant:
Print Nair,
Signature
I spree to
know that a
Date: l't 3".1 S
44