HomeMy WebLinkAbout1903 Churchill Ct - Applications/Reroof - 04/02/2012Or. 2. 2012 10:49AM Bob Behrends Roofing
No•6763 P. 2
City. of
6rt Cojjn,S
OVEN-7ME-COUNT90
Planning, Vevelcpment & rMnsportation 281 N. College Ave P.O. Box 580
Fort Coffins, CO 80524
Phone 970-416-274o Fax 224-6134
This application Is to be aisa&to apply for the following permits �� UPI Y
Demolition (interior non-strmtural) ❑Electrical Alteration (not service change)
all that apply).
C7 Heating Unit ❑ Lawn S pp Y)• Air Conditioning
prafsler ❑ Mobile Home replacement g) ❑Gas Lighter ❑Gas Log
CI Ventilation q Water Heater Q Water line ❑ X Hoofing. ❑ Sewer Line ❑ Photo -voltaic
manufacturer). Wood/Peltat Stave (must be EPA certified, provide make, model and .
Complete all applicable infonnation on the application. Application # Incomplete applications Will not be accepted,
112� US& Date Toro 11—i� a �-
Sob Site Address (required)
L Value of Construction (labor, materials, proft) .
Property Owner Name Address
City/State
ZIP Phone
Applicant Name Address 31� q a 4
City/state 25p Phone
Contractor 5� � • r-��
Lt ff Address City/5 to bb� a 5! D
rer.� s Y-II'll _ Zp Phone
Contractor City of Ft. Collins lad �'
Tax # �0�31 3 q 5-
Sold; trxnum� bar15��b,a, ojM Are you paying taxes here or by report? '
Are You y ? f� Here ❑ Report
Y pa)rin9 with our trust account. j� Yes O No
Is this a residential or comraenMt project? -V Residential ❑ Commercial
If residential, is it: J'singie
0 Mum ched ❑ Condo/townhome (single famil attac
If commercial' is It: p gam �r (apartment) q Garage y hed) ❑ Duplex
®iBar ❑ Church ❑ Hotel/Motel ❑ Medical office 13 office ❑ Retail
Is this buildln 5a 0 Reslau t ❑ Other (explain)
9 years ofagearmore? ❑Yes..,I Tfyes, YOU n�ayaeedtecontactHistor/cPreservavor�
If this Is for a demolition persta?, what year was the building constructed,
Ifpr/or to i975, you w///nam az6Fsment to submit wihy th/$ apP//�yon.
of work
*If lawn sprinkler/ba ow pre eder, must list licensed Plumber. If first-time A/C, must list lic
Subcontractors: list hge ll name Or QY ofR Ce//ins license ensed electrician.
Elecbioan Plurr>ler
----- Mechanical` Roofer
---�1 Other
I hereby acknowledge that I have �^
mad this application and state that the above information is complete and correct I agree to
comply with all requirements casUen herein and city ordinances grid state laws r ulatin building
permit is not valid urnll it isas8een paid and issued,. � g 9 construction. S know that a
Print Name:
��. v .a� •.OS Signature ���O.Jw (I
��, � care V`