HomeMy WebLinkAbout3001 Colt Ct - Applications/Reroof - 04/19/2012Apr 18 2012 5447AM HP LRSERJET FAX
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281 N. Col apmant & TrOnsportadon
Fort Collins, co BOS24 .o 580
Phone 970-416-2740 Fax 22"134
&'UVUA TER p1w%RMj73 ONLY
CT �" �kM Is to be used too a ! pp Y for the folio
wlhg p�nitFacke:
ahan (interior non-atructuraq C7 EleoKrioal Alteration (not se a" ��k a" that applY). p Air Conditloning
Q Heating Unit p Lawn Sprinkler 0 Mobile Horne replammentChange) 13 Gas Li LOU
O nufacl tlon Q Water Heater ❑Water Line ❑ Wood/pe Stove (mut be EPA weUna
U Lighter
mtakve �
manufacturer).
Gompieta $If applicable InforMation on the applloation. Inoom Iota model and
AppllCation # aC) o1ap� appftoatlOns will not bs eocopt.d.
For anx use �y Dite r
Job Site Addrew (,4)
,•._ _ .
Property owner Name
Applicant Name
711
Address
uc # Address
Contractor City of pt. Collins Sales lax #
.SakasAWMA WIfAWWpyayegflftC67M
\.11 .
Value Of COrtit UCU*n (labor, materials, profit)
" 7 n c t ^,
City/State 7Jp qy( —Zk Phone
1 1 .41 i1 t ,
QtY/ftte ZIP Phone
CILY/State bo—v1uer zip Plane
Are You paying " here or by report? M Here Ci Report
Are You paying with your trust account? ❑ yes Gh No
Is this a residential oro�tmerdai project? P0sldentlal i7 Cmmercial If resldentlal, is tt: f357ngle Family Detached 0 Condo/townhome (single family attached) q p,�pbx
If commercial, is It! 0 Bank C3 Bar tJ Church q Ham
L7 Restaurant p °tel/i�tel Medical office CiRloe ❑ RetaN
Is this building SO Years Otago mar (explain)
it this is for a damoiltlat or morel oyes ONO 11'ye� yver rwy mepr to eaatacrHatar><c pirai3rt�trari
n'phis I so for
d pit~ what year was the building eonsbucted?
1 *Yuneed an esbem7s Ommonent to subma wa M4 apWjmMan.
work
V lawn sprinWer/baddlow pre enter, must list licensed plumber. If rirst,tlme A/C, must list Licensed electrician.
Bubeontractors: LAgt M& cmWany name or aty ofR W#ns &vw #
BCcb7Wr, _ Plumber
McShenka�i; ttoolbr OMv
I hereby acknowledge that I have read this applkatlon and stele that the above Initfmration is regulating building Dorn late and
comply w1h all raM enterds c Wtalnad herein and city crdlnances and state Wmg GI agree to
parmlt 11 not valid until it has bean paid and taomW. construction. i know that a
Appikento
Print Narn
Signature
wm y/lg / �t