HomeMy WebLinkAbout5518 Fossil Ct E - Applications/Reroof - 07/31/2014OVER-THE-COUNTER PERMS ONLY
This application is to be used to apply for the fallowing permits only (check all that apply). 0 Air Conditioning
0 Demolition (Int dor non-structural) 0 Electrical Alteration (not service change) 0 Gas Lighter E3 Gas Log
Q Healing Unit ❑ Lawn Sprinkler 0 Mobile Home replacement g Roofing ❑ Sewer Line 0 Photo -voltaic
• Ventilation ❑ Water Heater [3 Water Line 13 Woo&Peilet Stove (must be EPA certified, provide make, model and
manuiactuner).
Complete all applicable information on the application. Incompleto applications will not be accaptad.
Application * Iq-D�Z Date �7.31 2014'•
For air" use only
Job Site Address (cequlred)
Value of Construcdon (labor, materials, pn*Q
55I Ftls`t1
CE. CAS}'• Z ou
Property Owner Name
Address Gty/Stabe Zip
Phone
2. r ewl
45A- E= 970-
Ra -1S-
Applicant Name
Address Cty]State Zip
Phone. 47a
ti44e-r m6k
-Tsnc all LJ• ETC Ca gOSaS
2.0'7-06"
CAnUaCtor
Address c6state Zip
Phone
Contractor City of R. Collins Sales Tax Are you paying taxes here or by repow ff�iere 0 Report
Ss1erawm, rrbrra rMquirrd byr8 =*BCWM Are you paying with your trust account? . VYes
0 No
Is this a residential or commercial projea? 11FResidendait C] Commercial
If residential, Is it: P1 Single Pamlly Detached O Condo/townhome (single family attached) E3 Duplex
0 Multlfamgy (apartment) ❑ Garage
If commercial, Is it: 0 Bank ❑ Bar ❑ Church 13 Holal/Motel 0 Medlcal office CI Office 0 Retail
❑ Restaurant ❑ Other (explain)
is this building o6 years of age or more? O Yes Ci tto if yesr yoy may need to cwJtacrHistuaitPreseriabbn
If this is fora demolition pent % whatyear was thir'buikiing eonstrudWd?-
Ifpriorfa 1973, ynn will need an asbaatas asseswment to submit Wffi this aMlnatiiara
Description of work o i- s-E-i vt w i-f-
Tc ten.
L
't it lawn nkler/b. flow .must list licensed pltmtber. If Rrs"me A/G must list licensed electrician.
Subcontractors: ulslroie mrnpenyname arclYeff3LbNmslhwae 3.
Decbidnn Plumber Meehenlral_• Roarer Oilier
I hereby admowledge that I have read this application and state that the above information Is complete and correct I agree to
wmply with all requirements contained herein and city ordinances and state laws regulating building eortshudtlon..I know that a
permit is not valid until it has been paid and issued.
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Applicant:vv�S 9pnatu;e
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