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HomeMy WebLinkAbout615 Langdale Dr - Applications/Reroof - 08/29/2014��e.sn�'anar�-oe�✓�odn�ac m a.wLnuvrinow arruWMMU This application is to be used to apply for the Wowing permits only (check all that apply). CI Afr Conditiodmg ❑ Demolition (Intertor nonstructural) 0 Electrical Alteration (not service change) t7 Gas Lighter 0 Gas Lag ❑ Heaffng unit ❑ Lawn Sprinkler © Mobile Homo replacement XRoofing © Sower Line ❑ Photo -voltaic Ci ventilation o Lnlater Heater 0 water Line ❑ WoodlPeffet Stove (must he EPA certified, provide make, model and manufactur?r)_ Completeail applicable information on theapplication- incomplete applications will not be aceepted- Appllcatiat7 R161-0 '7i (f e - Date Forofrrce use only f Job site Address (mv&lyd) Value of Construction (labor, mabadais, profit) l 15 L exy-,,A Aa1£ Z> 1f t7 Pmperry Owner Name Address Gity(5tata Zip Phone Applicant Name Address City/state. Zip Phone cl-70 - :iZ—vic- R.L'1 W 'C'•'ki §A lZX $658S 9-07-o4ffo0 Gontratlor Address -ty/Staffe Zip Phone Ccntraetc r 0ty of PL 001tIas Sates i ax = Are you paying tace5 here or by report? l��ere- E3 Report !! Salllaxmmrbcrrsreprrirzdbca lire you paying with your trust account? L�l Yes ❑ No 1 is this a residential orwrnmercial projec 1911esidential 0 Cnmmerdal if rasidential, is it Sngle Family DebdrPJd D Condoltrswnhnme Csingle family attached) 0 Duplex 0 Multifamily Caparhnent) 0 Garage If commercial, is it ❑ Bank Q Bar ❑ Church ❑ HWEYMotet 13 Medicdi office 0 Ofrioe i] Ret3T1 0 Res—Murent 0 other (explain) rs ;his building So years of age or morel ❑ Yes U No rfyes, ynu•mayneecl as canwj:rH wicPrt5a- affcn If this is for a demolition permit, whatyear was tht+bt ikling constr kked? T(Qrinrro 975, you w .#1 nead'an asbaFbs assE--RrrFutmsubmirwdfr bris appfrraaan. Of IiI, lawn sprInklerybaclalow preventer,must list licansed plumber. Tf arst-iimeAJC, must listlionised elactrtdan. sub con'racters:List MecomAanYname orGryaFRcaflinsffma 2 i7eebicien plumber. i4ecieonlcI Roofer �` 1T69 Other li hereby 2clmowlertge that crave read this application and state that the above I•niormalion is complete and correct I agree to comply with all requirements eontalned herein and city ordinances and state laws regulating building construction. Z know that a permit Is not valid until it has been paid and isGued. Applicant? jpl T Hmr� '.] £YifA l S S;ynntuce Date Print Name' r