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HomeMy WebLinkAbout2001 Timberline Ln - Applications/Reroof - 08/05/2014uvr.K-1 HIM-Guun 1 MIN MINORU BO V11111 i.1 This application Is to be used to. apply for the following permits only (check ali that apply)-10 Afr Condlaoniq ❑ Demolition (Interior non-strucLural) CI Electrical Alteration (not seMce change) ❑ Gas Lighter Gt Gas tog • Healing Unit 0 Lawn Sprinkler ❑ Mobile Home replacement Roofing D Sewer Line ❑ Photo -voltaic E3 ventilation ❑ Water Heater ❑ Water Line 0 Wood/Pellet Stave (must ioe.EPA certified, provide make, model and manufacturer). complete all applicable information on the application. incomplete applications will not bo acc©pted. Application# 1, 14OS.Ilq. Date Ob•b5.2Di4 For ofike use only Job Site Address &wiflred) Value of Construction (labor, materiels, profit) + t{V��Tt Yi,y�i itV'i E'. Ln. rty Owner Name Address City/5'tate Zip phone 6ne Applicant Name Address City/statie Zip Phone Cl -A9 - iR��ros'cQable i:Go� Sly all l F`Iz $asas �a�-oaoo Contractor Address dwstate ZIP Phone Contractor City of Ft. Collins Sates Tax F Are you paying taxes here or by report? Ef tiere 0 Report 4Wsw&Ymmhr& wuUrdbYa9 Are you paying with your trust account? OR`Ws 0 No Is this a residential or commercial pMed? Ifs Residential 17 Commercial If residenda4 Is It Single Family Detached 0 CondWtownhome (single family attached) Cl Duplex it Muitifamily (apartment) O Garage If commercial, is it ❑ Bank 17 Bar ❑ Church ❑ HoteilMOW Q Medical office a Ofilce ❑ Retail Ci Restaurant ❑ other (explain) Is this building 50 years of age or more? 10 Yes Q No FfYes� youmaYneefl to canted HlsteortcJ Brvatiarf if this is for a demolition perynita what year was th&buildlrr constructed?- .rfpffor iv 1973, you WAI need'an as$esras assessment iv submA, kdhi dris aPPYcarinn. E o wi Description of work e r i- r� � fvr - r�S Cy �� M %%r lawn sprinkler/backflow preventer, muet list licensed plumber. If flyd ` ime AIC, must list lleeilsed electrician. Subcontractors: Ustthe COrrP"YRNMO C&Ora CWAelxsllcensa.fi ©ecbtcian wumacr Hadranlml� — Roarer Other I hereby aamewtedge that I have read this appiketton and state that the above Information is compiete and correct. I agree to Comply with all requirements Contained herein and citY ordinances gnd stage laws regulating blfitding construction. I know that a permit in not valid until it has been pold and issued. f r ' Applicant: PetntName• Pru< Ili -en v�i te S Si®natu i