HomeMy WebLinkAbout4217 Breakwater Ct - Applications/Reroof - 08/08/2014lob SRO Address &Squlred)
Value of Construction. (labor, materials, profit) .... ...
�ta1�- re-e�r Ct
....
Pr—Vly Bwnnr Moor- � � ..... .... Addreeva �...
... .. ...... CJIY,GMte - .MP
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Applicant Name.. Address
CItY/State Zip Phone
contractor .... .. . ' . .. .. - ...... Address , .....
..... .. atvlsmna. i✓[.k?i..5vc�ri Zip ..... .. w,one
Contradvr City of Ft Collins Sales Tax #... ......
Are you paying 1 here or by report? p yyere ,,Report ."
_4; Ms tar aAcnvrbaCMM
I ram'_ �4'SIrL`a
Are you paying with your truss. account? Yes ❑ no
...
Is this a residential or c9mmerclail project Residential 0 Commercial
If residential, is it: Single Family Dcad ed ' "0 Condo/bownhome.(singie family attached) ❑ Duplex ..
O Multifamily (apartment) .0 Garage
If commercial, is it: 0 Bank 0 Bar 0 Church 0 Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or mare? O Yes 0* Ityes, es, you may freed to mntactHLs&k Prime tfbn
If this is for a demolition permit, what year was the building constructed?
Ifprior to 1975,. you will ncad an asbestos.asses_went tosubmit wilt this aXBrabron.
Description of work
A
*If lawn sprinkler/baddlow preventer, rntisi list licensed plumber. If rst-time A/C, must list licensed electrician.
Si nouctors: t cis e.compianyname or,atyofPtColllfw&errse #
8ectridan Plumber Medrankal Roofer other
1: hereby admowtedge that I have read this application and state that the above information is complete and correct. I agree to
comply with aft requirements contained herein and city, ordinances -and slate laws regulating building construction. 1, know that a.
permit Is not valid until it has been paid. and ksued...,
Applicant:
Name: �\tu F��.y1�GR signawr�o Dees. �— �� I