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HomeMy WebLinkAbout5209 Mill Stone Way - Applications/Reroof - 10/07/2014Planabier 281 N. CoUege Ave P.O. em Sao i Fort CoUfrS., CID ODS24 Phone 970-416-2740 Fax 224-6134 This appf cdbn is to be used to apply for the foamwft pe m#b only (off an that apply)L 0 Air CorKMbnjW8 O won (fr>ewW non-structursi) O Elecbw Aiterow (not sevice charge) ❑ cas Low 0 Gas Log O Heating Unk ❑ Lawn Spnnkfer © Mobrle tfoine rent 0 Roofing O Sewer Line O Plwto-alc 0 Ventlation 0 Water Heater ❑ Wrier tine 0 Wood/Pefist Stowe (must be IPA cedifted, provide make, model and matwfaoturlid. Complete all spokable infamm tonon the application. tncornp� � will not be accepted -I-_—. TI'"—� � 6 I �0 I "C0i-7(YnDate /0 _ 7- /r01rGV9RCti' GiSL' fA!)ly ]oft Sibs Address (MV,lVd) 5�oj MiQs+o&.,-Ula EtCollit3 52- Value of Cons&Uc an (abor, msherids, prOM) $ 23od,d�I ftnperty Owner Neine Address city, state ZIP Phone y oz r4S 3Q8- q32- AppUcant name Address city/state ap tie J e r v/; h 2A 4 Lo ve NSP6 7 - I Z Contractor Lf< # Address aty/state ZIP Phone 3e s o -113 S6vv\ Cormactur City of Ft Collins Sates Tax # Are You paoV taxes here or by reM Here O Report mast? 0 Yes Na taprixmtbeDrar dtsl' Are You PaYin9 � Y� �ft this a t or Commercial pro t ) Q Dupiex SIrKjIe �Y If edertlaf, Is C]'MuWamil (apartment) O Gwa9e to Bank O liar D Church ❑ t OW/P40 of O Medical dit O ante O RMA If 01"Merd84 is it: 0 Restaurant ❑ odw (explain) m / parkcPn aervadtan WHO* 90 YMMof ap or more? 11 Yes V No ff^ yrw /MY IS this if this is for a dam+ PwuK► what Year was the building consdvcted? need sn asr s to wbmt W/br bws Wod lYCirbv tb 1975, yew rvN! IC Descries C)f vuark eOi @ 1 aIf p emft mum fist Doensed plumber. if first-time Al4 must fist fta d fawn %xMjdW/b � tier rYreearoeYofR� ��GjZ_ c�►'+� piwl______._-- aboveand thit the hoormadoo is mriplete and WnVM I SWM� ifiet a hereby adawWW2e that I have read this aPPRGN" aW ste taws regu�9 6 N&V 0°*an' "a I herein with hM dean Paid aged mod' p wk na vs®d� Applicallb Pie Monad: W t �� ) U sionaturw cain