HomeMy WebLinkAbout2515 Rock Creek Dr - Applications/Reroof - 08/05/2014O.W. ER -`SHE -COUNTER PERMIT'S ONLY
This application Is to be used to,appiy forthe following permits only (check all that apply). ❑ Air Conditioning
❑ Demolition (interior nonstructural) 0 Electrical Alteration (not service change) 0 Gas Ughtor a Gas Log
Cl Heating Unit ❑ Lawn Sprinkler O Mobile Home replacement Roofing ❑ Sewer.Line ❑ Photo -voltaic
❑ Ventilation 13 Water Heater ❑ Water Line Cl WoodrPellst Stove.(mustbe EPA certified, provide make, model and
manufacturer).
Complete all applicable Information on the application. incomplete applications will not be accepteii.
Application # 1514,50g9 • Dane a$ OS 20l
Far offlce use only
Job Site Address (mqulmd)
15 oG1C deeY,
T)r-
Value_ of Construction (labor, materials, profit)
Properly Owner Name {�
" _ 1 m '\Ll 1 f'
Address
City/State Zip
1�1�
Phone.
inoz I .2zo 3z r13
5-4
Applicant Name
-Address
Crty/St eba Zip
Phone cI "76 -
A; ,e-,U0Le ReaG T
at°i tJ. ZX Ca $oS&aS 2.0-7-0600
Cbntxactor
Address
iv/State Zip
More
Contractor City of Pt. Collins Sates lax
Are you paying taxes here or by report?
Her 4 ❑ Report
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Are you paying with your trust account?
WYes ❑ No
is this a residential or commercial project? • WResidential ❑ Commercial
If residential, Is It: P Single Family Detached D condo/tornmhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church O Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
Q Restaurant ❑ Other (explain)
Is this building 80 years of age or more? ❑ Yes O No rfyas. ywmay need to corttactiffsfomeR senrablan
If this is for a demolition perlittt, what year was the-buliding consfnia0ed3
rfpnb rto Z9TS, you wpl need an asbestos as omerrteo sutmft with M& epplic ML
Description
'kIf Lawn sprinidQfbaeldtow praventer, must Rst licensed plumber. If find -time AX, must fist licensed electrician.
Subcontractorsr List Me compeny name or 01Ycri `CWiW&Vnse. A ��yy
9eebidan _ _ Plumber Medtanreal Roorer ram-' i 8'Sy Other
i hereby ad(nowledge that I have read this application and state that the above Information is complete and correct. I agree to
comply with all requirements contained herein and city ordinances mind slate laws regulating building eonstrueftn. I know that a
permit is not valid until It has been paid and issued.
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