HomeMy WebLinkAbout4507 Goshawk Dr - Applications/Reroof - 09/14/2014s
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This application is to be usOd ip apply for the following permits only (oheck all that apply). 0 Alr Conditioning
o Demolition (intertar non-structural) Q Electrical Al aratlon (not service change) iJ GW Lighter ❑.Gas tog
12 Heating Unit 0 Lewin Sprinkler El Mobile Home repiammont �iRoaring Q Sewer Line ❑ Photo-voitalc
LI Ventitston D Water Heater C1 tnlater line 0 WoodlPellet Stove (must be EPA certified, provide make, model and
manutaclurer).
Complete all applicableinformationon the application. incomplete evDiloatione will not be accepted.
Application # Date
For ofirce use only _-_
Sob Slte Address (revur5edj value of Construction (labor, materials, profit)
1-150-1
Pre r rty Owner Name Address ctty(State Zip Phone
l re.
Applicant Name �p r Address Clty/SRate Zip Phone
A r�w(a�P 1n, Z.vt 2ttril W.'I^ci�� leer i-`C-r- Cd Flbss a
Contractor Address ty/state Zip Phone
Con'rrscWr City of Ft. Wilris Sates Tax Are you paying t ores here or by report? re a Report
safer tvx,aanberrrmquired byaUCMIFI' car:• Are you paying with your trust ar oaunt? '2"Yes 0 NO
Is Oils a residential or commercial pr*d? iV Residential Q Commemai i7 nu ex
If residential, Is it. q Single Family Detached 1� Condoltownhnme (single fainlly attached) isf
0 Multitamlly (apartment) . Cl Garage
if commcrciai, is it: ❑ sank ❑ Bar I7 Church ❑ Hote1 f At W 13 Med(W office Q Office 13 Retail
Cl Restaurant ❑ Other (explain)
Is this building 5o years of age or mare? Oyes ❑ No Ifyes, you may need iv Ctznrac HWl;Wrfr Plesermffen
If pFf is for a dernotitlun will need an a what
sbastos aaasemm t to svbm�r`+th� �+V "f
Ifprfor0 i97S, ym
. tiu _ t
work
*Ir lawn sprinklerlbacMlaw preverter. must list licensed plumber. If tirt time AJC, must list kitensed el2Ctncian-
Subeontrearnrs LirtMecompgrnynamaorCWY°fRa0w ffcwsv
Medianrta{ Roarer S: i V � 9 Other
flectridarL_�..� PGrrrlher -
i hereby aclmowledge that I have read this application and stage that the above inibnnation is Complete and correct. I agree to
comply with all requirements contained herein and city ordinances and staff laws regulating building comitructlon. r know that a
permit is notvalid until it has been paid and issued.
A4.
p ptteantrm-�1 l _t �{ r
r Date
Print Nae. vK `i Z n 1 S 5lgnatul�.: '� ... 1
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