HomeMy WebLinkAbout2521 Rock Creek Dr - Applications/Reroof - 09/15/2014This application is to ba used to aAP1 rorthe followim
s Permits only (check all that apply). CI Air Conditioning -
13 Demolition (interior non-structural) 0 Electrical Alteration (Doi sarvice, change) 13 Comas Lighter 0 Gas Log
El Heating Unit ❑lawn Sprinkler iJ Mobile Home replacement X Roonny t3 Sewer Line O photo -voltaic
r r tteniiraion n Wettar iieater 0 watar !.!ne O llVood Pelfut Stove (mus'cbel EPA eel imed, provide makc;, model an[f -
manuraciurer).
Complerteall applicable information on the application. incompleic aaplicaFionswi{I not bo acconteC. -` s"'
A llcation ; Date �� v%
�1 Y4Y
Farofirce usa only
Sofa site Address (ragrdred)
Value_ of Construction (labor, mateTTats, proFit)
Property Owner Name Address
ary/state zip Phone
Y1 t_ in a -Ch Vr 0
Applicant Name Address
PI I - Q
City/state ?fP Phone qua
y,C _ at ri t.J_ 'l c alba Vco, F-Tt Ca &OSP-S
Coritrft! Address
lty/State ZIP Alone
s Contmctor City of Ft. (bilfris sales-,ax =,
Are you paying taxes here or by report? @1'ljere 0 Report
I serer iarntm AY,( rc'4vbwbycit con mea=
Are you paying with your trust aceounV 1�Yes [] No
?s this a reMdemiral orcommer3al project? MRwdential 13 Commercial
T re_sldendal, is il' 19 Single Family Detached l•`_E Cando/tawnhome Csingle ,%m7y aftched) Cl Duplex'
G Multrfamily (apartment) 0 Garage
I; cornmemial, is ra 13 Bank ❑ Bar El Church El Hotel/Motel ❑ Madir of o fCe o ofdoa i3 11eta11
CI Re:iaurant 17 Other (explain)
is this building 80 years of ege or more? ❑ Yes ONO .ifyes, you mayrised fo coatacthrstariccPre-cemiion
is this is fcr a dex:crlhicn pernif, what year vim tK-buitding consh-jcbad3-
Ifprinrla 1 a7F, you ux71 aced i?n asi�esttis ds`,�SrRfi4rti7 strbmfctviih ifrrs application.
work
if lawn sprinkler/badv'iow preventer, must list kensed plumber. If fiat -time AIq must r15t roWei electridarL �Z
5ubcot actura,-?AtMemmpany,%wvcu-GryoPFc'Collias/(canwi
leccbidar, Plumber rlerhsniea!• _ Rarer R. 17"E'?, other
r tiareby admotvledge that.I have read iris application and slate that the. above rnrom Uon rs complete and mrredt. i agree to
comply with all requirements contained herein and c%y ordinances 4nd state laws regulating building construction. 's imowthata
permit is not valid until tY has been paid and issued. ?
Appllcadr:
grin; flame: AIA&rn <e-TAINT S gig>zatur`e e � 8atc 7
r -lam
9
�` ` •ss ic�_'I
' i t