HomeMy WebLinkAbout1013 Deer Creek Ln - Applications/Reroof - 08/19/2014OVER-THE—COUNTER PERMITS ONLY
This application to to be used to apply for the following permits only (check all that apply).13 Air Condittanmg
❑ Demolition (interior non.struduml) 17 Fledrical Alteration (not ser Ace change) O:Gas Lighter 0 Gas Log
Li Healing Llnit 0 Lawn Sprinkler 0 Mobile Home replacement )KRoofing 17 Sewer Line U Photo-voltela
0 Ventilation 0 Water Heater 0 lWater Line ❑ WoodlPellet Stove (must ba EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. incomplete oPolfoations will not be accepted.
Application # 514-0(o+tat Date
For office we wily
Job Site Address (m7idmd)
ValueLof Construction (labor, materials, profit)
U !3 Deems CLn
2,500.00
Propene/ owner Name Address
r r CA
city/state Zip
CI?U - 3 l a- rc
Phone T
Applicant Name Address City/state Zip
��
Phone R -;w -
CantracW_r Address
ry/state Zip
Phone
ContriscLar Clay of FL Collins Sales Tax #
Are you paying taxes here or by report? ff1eC
0 Report
sales tarawnberismqurmGbyanm final=
Are you paying with your trust account? 2'Yes
Q No
Is this a residential or mmmeraai protect? - 9 Residential Q Commercial
I; rrsidenWil, is lC. C1 Single Family Detadwd Q Condc/Eownhame (single family aft &ed) 0 Duplex
❑ Multifamily (apartment) 0 Garage
If commercial, is it: 17 Bank ❑ Bar ❑ Church ❑ Hotel/Motel D Hedical office ❑ bhtce ❑ Retail
Q Restaurant Q Other (explain)
I-. this building So years of age or more? O Yes D Na Ifya. yoymayneed to cunbctHisiw Pleswwtion
If "s is for a demolition perynIk what year was fhb -building aonsbiided?-
tfprler.Y� 39y'.i, ynu wr71 ne�l'arr asb�stasrtm sr/6rnitwfGh drl4appUratlon.
Description of work _
, f lawn sprinider/baddlow, preventer, must fist licensed plumber. If BrstWme A/C, must list flamed elecbidan.
Subcontractors:I,Istb7rmarpsnyaemearL7lyafFtCdOaslkease l
eecawcyan Plumber Med2rdCal Rooter�_l85^ other
I hereby acknowledge that I have read Uris appiication and state that the above inibmrations complete and correct. I agree to
comply with all requirements contained herein and city ordinances and Slate laws regulating building construction. I icnow+hat a
permit is not valid until it tree been paid and issued. ;
Applicant: Jiiy
f.^ e `
Dr9ni Namfe: ri n 'J PLVI l ]RR S mgnatwe r--? / Date
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