HomeMy WebLinkAbout2045 Churchill Ct - Applications/Reroof - 08/12/201413 nvr. tltlll lt= �i®�H@IH�."BU M Own GtlV00 llO .�vr�.�
?his appAoation.la to bB used to apply for the following permits only (check all that apply).
17 Air Condltlonmg
0 Demaiition OnWor non�nucturaii O ®ecilical A►tmUon (not service change) 0 das f_1.9ftt U Cyan tog
❑ Healing Unit 0 Lawn Sprinkler ❑ Mobile Hams replacement Roofing 13 Sewdr Line 0 Photo-vokalc
Q VenbIggon II 1Naier healer Q Wader Lino 13Wcodipaliet Sbve (must tie EPA techhfisd. provide males, model and
manufaLl uref).
Complete ail appi�ble information on the application. Incomplete apprtlorra. will not be accepted.
Application # 'F2140io l 12 ,_— Date
Aarm7ce use only
]ob Site Address (rawked) value:of Construction (labor, matedit pmiit)
ey
H 6 C' tNuf Gh i1 O Phone 7J0
Address Cityl5ute ZiP
Proper4rO+NnerName gg9-'3953
_ E d C:7 . Ci ylstate y ZIP Phone ti
Applicant Name Address
QI r�cibl a 'P oo�i = rn a 1`l W- -CrIr iZ cQ ''- ca
Phone
$oSaS aLa7-oao a
contracmr
Address tYl �P
Are you paying taxes here or by n?par� 1►�Fjere 0 Report
CCntrador City of Pt. Collins Styes 71DC Are you paving with your mist acoount7 es ONO
S�w,��rrwmEerltrreGr+++Bd bYa+�' ��
is this a re identlal or commerrJal prolleW W homm (e 9ie family attached) t7 DUptex
If residentlsl, Isit 'q S1ng1aFamtlYD❑alXhed p Garage
0 Numfemily (saparbmnt)
If Commerdel, Is it: ❑ Bank 13 Bar 17 Church ❑ lio allMotel 13 Medical OfRm O office O Retail
0 Restaurant 0 Other (explain) u pray treed tri copract hlis6orit Presw a�
Y9 Ws buildiftg 5U years of age or more? O Yes D No Ifya* Yo Vda-
IPihisisforademolitionPOUnit�r ryq aplod�bo►x
Ifprfnrto 197S yoiv.11 need al) a5bgsM9
of
R'tP lawn �iinlderlUsdutow Preverlter, mus< list Hammed plumber. It fh*dme AiG must list lio3r►sed etoCJ9dan ✓
Subcontrectarai Iftiiv"M myp3mzorJWofnIWIMllcarrre
etsr"- -
Medianrcet Rooter R- i o s other
9estrlrla�.._.---
i hereby atlas l req ge mEmtOvatl have
read ttu9 ept►Hw1zon and slate that the aboug h$armaUon is � and correaL % Wee to
I hereby
omply with to le dUemants opmstned herein and sly ordinBncPs-4nd gb3te laws regulating buRding Construdion. Z lmpwt9rat a
permltis notva116 until It has been paid and issued. {
Appirearft
PAnt Name' li