HomeMy WebLinkAbout1100 Live Oak Ct - Applications/Reroof - 07/03/2014City a
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This application is to be used to apply for the f
❑ Demolition (interior non-structural) ❑ Electrical
0 Heating Unit ❑ Lawn Sprinkler ❑ Mobile Horr
❑ Ventilation ❑ Water Heater 0 Water Line ❑'
manufacturer).
complete all applicable Information on the ano
Application #_012�1 L7 �% 5 S
fora/i&� rise any
Planning, Dewebpment a Transportation
281 N. College Ave P.O.Box 580
Fort CONIM, CO 80524
Phone 970-416-2740 Fax 224-6134
PERMITS ONLY
lowing permits only (check all that apply). O Air Conditioning
Iteration (not servfoe change) ❑ Gas Lighter 17 Gas Log
replacement 19 Roofing ❑ Sewer Line O Photo -voltaic
Dod/Pellet Stove (must be EPA certified; provide make, model and
Incomplete applications will not be accepted.
Date %-13~ 11
lob Sfte Address (naqwyed)
Value o(Conobvictlon (labor, materials, profit)
CL 31
C2
I y8
Property Owner amenn
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Addle Cky/Statse Zip
Phone
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Applicant Name
Address City/Stdte Zip
Phone,
Contractor
Address City/State ZIP
Phone
P) 6 e.Y'CL
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Co� City of Ft. Coriins Sales Talc # Are you paying faces here or by report?
0 here ❑ Report
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Are you PBYW9 With Yon' host account?
E Yes ❑ No
Is this a residential or comrneraal prow? ire Residential ❑ Commerdal
If residential, is it: 8 Single Family Detached Q Condo/l owgnigme (single family ate ❑ Molmc
0 Multifamily (apartment) M Garage
If commercial, is it 0 Bank 0 Bar ❑ Church Q Hotel/Motel 0 Medical office O otpee 0 Retail
❑ Restaurant CO' Otter (acp aln)
Is this building 50 years of age or more? Oyes g No If yt you may need ib mrttdut f//SIGrAc Preserretiart
If this is for a demolition permit; what year was the building aonstnxtied?
If prior to1975, ym and/need &i ea estus &%awnerttto.RrbnNtWW 6VS
Description of work
*If lawn sprmlder/baci low pmenter, must list licensed
subcontractors List the cnfttpWY tArmie a OtY oltt E
.. If tirsktirne A/C, must fist licensed electrician.
#tlf'&Vn5e S
R 1.5 /o _ Other
I hereby acknowledge Vic I have road ibis application albd sUft that the &bare W*wo m ig WrWlete and correct. I agree to
comply with all retiuirement6 contained herein and city oldinartoss and state laws regulating building construction. I know that a
permit is not valid until It has been paid and is�,erjl.
Applicant
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print Name _ 6beP� I..]_ �d A Signature ' " — Dribs 2-3— I `l