HomeMy WebLinkAbout4001 Benthaven St - Applications/Reroof - 08/29/2014This application is to be used to apply for the folkWing permits only (cl-reck all that apply). M Air Conditioning
17 Demolition (interior non-structural) 0 Electdcal Alteration (not service change) 13 Goa Lighter 0 Comas Log
u Heating Unit Q Levin Sprinkler ❑ Mobile borne replacement Roofing 0 Sewer line 17 Photo voltaic
r i Ventilation l] Ifllatgr Heater 0 Water Line trVooCY et SLove (must be EPA certified, provide make. model and
manuiaciurer)-
comolcto all applicable information on the application. Incomplete applications will not be accePted.
ApPlicai3tlr► # —
Far ofiica we only
lob Site Address (requnzd)
property Owner Hama
Applicant Name
contractol
Address
Date
Value of Construction (labor, materials, profit)
Address Ciylstare
at'l lad. �Cr-ikllau% IZA
,address dmvstate
Zip Phone
°70=9r17-5ga
yip Phone q70
$OS� S 2a? -Goo G
Zip Phone
Contractor �ICj� 8t Ft. ColEirrs Sales i ax = Areyou paying taxes here or by report? Lff}jere 0 Report
Are you paying with your trust account? ITYes fl No
s3fesfaxaumberf9'r44U& d hy'd,Wn=eRr
is this a reddenbal or commercial prnject3 l Residential i3 Commercial ❑Duplex
if residential: is it: t% Single Family Detached u Condolto+Nnhcme (single r'aa attached)
b Mnifft'amily (apartment) 13 Garage
IL, cornmercl-al, is it ❑ Bank Q Bar U Church C7 Ho-jeljMotd U Medical office ❑ OinCp ❑ Re�il
G Restaurant ❑ Other {exoiain}_
Is tins building so years of age or more? O Yes iD NO byes, you- maynard m comta HlsmricAeservaablan
if this is for a demolitior. pe.^nit, whatyear was thi buiiding cor[&6eW d?-
lfOrlarZu my, you still need an ashavrosassessmentras.ubmicwlth difsappGc8uon.
of work
*If lawn spriawer/bam w p e enter% must hstGoensed pbimber. If first time AjC� must fist licensed electrician-
-sub runth-actars- Lt'thecampanynam2 or CW6fFYColilns/lcer�:`- ` u a a
Eledri8ary
Plumber i,teclraitin, l ROVer P ��_ other.
? y acraro� fledge that l: have read t is application and state that the above iniornrratlon is complete and correct. m
grPeto
hereby ow t at a
Cora eb with all requirements contained herein and dtY ordinances and state lays regulating building constru�on.
permit is notvalid Until it has been paid and iomrcd-
r`1 f.� : Date
Applicant +1 n&G �e-+AVL 1 i� S signature J _ "'�_ �''
Print I'FRm2* 7i —� -
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