HomeMy WebLinkAbout2412 W Stuart St - Applications/Reroof - 04/18/2012Fc i s
Plarlq�9� D19Y �rTrat�Orlat�+t
2111 R. College Ave P.Q.. Box 5W
Fort CcM WSZ4
Phone 970-4W-2740 Fax 22+6LM
OVER=THE-MU T"ER P'ERWIS.ONLY
This atpplication is to be used to ripply for the following permits only (chaek'all that apply). 13 Air Cdnditloning
Ea Dermll ibti (ir edoe non-structural) P Electrical Altaretlon (not rArVido change) b Gas Ughter 0 Gas Log
Q Hdatirrg Unit C7 Lawn 5prinKer E3 Mobile Home replacement Rooting ❑Sewer tine Cl Photo -voltaic
Qi verttil"m 0 Water heater Ct weter .Line Cf Wood/Pellet Stove #rent be EPA certified, providernal a, model and
maritrtachtrer).
Comph":atl applicable inform moo on the apokatiom 1npomotaft apPi(cetMgne. wfll ttot be accepted.
Application # 1 a� l �S net i g AI�1
rqenv a0*
aab Site Addrem ,(r W#4
Value of Co n (Iabgp mattaeriat&, per)
VOL
dgI12 t_t_�, s+��.�} sa-
Property Owner. Name
Address ClWState .Zip Phone
(9, h- (� r • 30
ApAy®irt Name
Uft
Address C4/Stabe zip Phone _
Conpactor
Address. CRY/State Zip Phinne .
CvrltraMr City. of Ft. Collins Sales Tax iy Are you piMng xes Woo or byneport7*tiene.DFwcrt
S s.ts� >i ,��7'ancnriharinrx
Are You paying with Your trust agnunt? .D Yes'
is tws a residential or commercial project? p4tesidentiai 0 Commercial
If residential, is M 0 Si_rupe Family Detached C) Condme oAnwriho(single familyG aim o*d) E3 Duplex
D MW.Warnlly (aoMnent) Cl .foliage
t€ cocnit ndai, as 1> Q o ear a l tkgo E3 rlotel/Nt�t IQ Medal Wince � office E3 Wall
[3`A" aurant C3 outer (ex ain
Is.this bugoinq.." years of age or more? D Yes ffm, you mayrndW to c tit HisipyicPr eno6brr
If lftls is far a diatW*W*n permit, What year was the buildhtg oonsttutted?.
Af prior W 1975 pw wW need an eEbesivs a vit:tb 3V&Mr graph thLsal W A:01fft
°®
*If lawn sprirdderlbaddt m preverder, must 11A'Ntensed p6rilbe, V Mst trm A(Cv must 11st lkensed elettridan.
ors: Lfst ble=V'V WnameorOW ofR.Clow i e Ar
Elec an Fkartber. M ca1 Raofer CJther�
I hereby admmim* Out I have mad Mdsappfler M and babe that the lnfbmratian is comple>e and Cbt i agree tp .
anrror mm of mgWramernb aQrttalrted Wain erb dty orrl�r�as��iavvs�laRytg: btdding uxtstnocUon. > lnloq+ttteta
pamttt is tint valid undl, R has been paid mod iesmA.,