HomeMy WebLinkAbout4566 Seaboard Ln - Applications/Reroof - 07/11/2014Jul 11 14 02:02p Elite Roofing 3032433215 p.4
FCiof
elt Cottons
Planning, Development & Transportation
281 N. College Ave P.D. Box 590
Fort Co*ns, CO 80524
Phone 970-016-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check an that apply). ❑ Air Conditioning
0 Demolition (interior non-structural) 0 Electrical Alteration (not ser3& dnarge) ❑ Gas Lighter ❑ Gas Log
O Heating Unit 0 Lawn Sprinider 0 Mobile Home replacement M Roofing 0 Sewer Line ❑ Pholo-voltaic
0 Ventilation 0 Water Heater ❑ Water Line ❑ Wood(Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete arp-lplications will not be accepted.
Application * For Y) I `+ l) 3�GG) 025 Date I (_� I � I S 5
-13
Job Sibe Address ! I
Value of Construction pabcr, materials, profit)
pOwner Name Address
Coy/State zip Phone
aYQ - 3 7Q
V.o
Applicant Name Address
City/State zip Phone
030
'fi a
Contractor Address t
city/State zip Pie
s
- i
contractor cityofFL Coirnna lies Tax #
Are you paying taxes hereor by reporQ IrHere ❑ Report
WWO
�'J, „�Dj m per„$
5 O`6 S
Are you paying with your bustaccount? ❑ Yes
is this a residential or cogimacial project' Residential ❑ Commercial
If residential, is It: 3Sfngie Family Detached ❑ Cendo/townhome (sngle family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it ❑ Bank ❑ Bar ❑ Church ❑ Hot Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ other (explain)
Is this building So years of age or more? ❑ Yes "o If yhs you may need to carrtad /lesraric�ienvretrion
if thts is for a dmaoBdon permi% what year was the building constructed7
lfp w m 1975, yew wml need an asbesWs assem"M cam submk wr77r tics aAP*3&•
Description of work —
S
*If lawn swinlda(baddbw premriter, must list licensed Plumber. If first-time A/C, must list ticersed electridan.
Sall - bactwwlistthecon4wWnameorGtyof)TCatiMAtm•tse#
8ednow Plunba Medarirat Roofs Other
I hereby ackravtedge tlwt I have read this appRaton and slate that the above M ffnation is rnmplete and correct I agree to
comply with all requeemerrts cortmened herein and dty ordnance and stage laws regulating building construction. I know that a
Penn* is not valid uttll it has beep paid and Issued.
t, I
Appill hht Data \ ..-(>Z '
Print*Name: en- tl{7 �=t'r signature o.._:.L�.