HomeMy WebLinkAbout4945 Pyrenees Dr - Applications/Reroof - 09/02/2014City. of ! • Devak*mw* a TransimmUtion
C.ollins 281 H. College Ave P.O. Brix S80 v
Fort ate, OD 80524
Phone 970-415.2740 Pcw 224.6134 o
OVER-THE-COUNTER PERmrm ONLY
This application Is to be used to apply for the fbiloowing permits only (check all that apply). CI Air Conditioning
13 Demolition (interior non-structural) C] Electrical Alteratlon (not service change) 0 Gas Lighter ❑ Gee Log
0 Heating Unit ❑ Lawn Sprinkler 0 Mobile Honga re nerd % Roofing 17 Sewer Line O Photo -voltaic
0 Ventilation 0 Water Heater O Water tine 01�Vood/Pe
manufacturer).
Compfeie all applicable Information on the application.
Application # T> I aQ,�
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Stove (must be EPA oertlfled, provide make, model and
Incomplete aoplicatlons will not be accapted.
lob Site Address < J
i Value of Construction (labor, materials, profit)
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Wicant Name Address
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ZIP
Phone,
Condador Address
CKY/State
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Phone
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Catractor City of ft Collins Sales Tbx
Are you poft tames here or by report? 0 Here 0 Report
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Are you p*V with your trust account?
0 Yes O No
Is this a residential or commercial prow. 0 Rr
If re al, is it: 0 Single f De#aoW
0 Mum (apartment)
If romrtWdal, Is I a Bank 0 ear 0 church
❑ intaufant ❑' other (!
rs this building 80 years of ape or more? a Yes
If this Is fix a demolition penel1; what year was
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*If lawn apriniderybaddlOw peeve dw, must fact IlCerwd
tfobo mbaetom L� dAie mnpany nee cv Qry afR !
ential . 0 Conxnerciat
Coedo/iJ wnhome (single y attached) O Duplex
Garage
Hobe(/ 40tel 0 Medical office 0 ofitee D hefts
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Ii f rA-4Lne q/r, must list lioerx51 electrician.
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I hereby adorovMedW that I have read this application 8#d stale that the Am infomotiar is oxnpkte and can I agree to
cmvfy wfth all requkerrwft cmtalhed herein and city o dhtancea and state tests titdOV owistr utfon. i know that a
permit is not vabd u o it lee I , pdd am bsUM .
Applicant
Date
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