HomeMy WebLinkAbout3626 S Timberline Rd - Applications/Reroof - 10/24/20141'
W A'. f �r able Roofing
Fort Collins
OVERM
This application is to be used to
0 Demolition (interior non -structure
Q Heating Unit 0 Lawn Sprinkler
0 Ventilation El Water Heater ❑
manufacturer).
Complete all aWlieable infdrmati
do-dod paogaj al jalanaJ auawa6jetp
a v?A0a3 qQ?0sar{&%g Nov 81TM9:
281. N. C7oilege
Fort Collins, C(
Phone 970-411
LINTER PE[TR As
09l s a3 V 4l�eges ei zesnan
)14 MSP Page a� a age} sa}lanb.13
P.O. Box 580
Fax 224-6134.
0�
ifor the following `pormits only (check<alfthatapply). Q AirCondinoning
Electrical Alteration (not service change) ❑ Gas Lighter .0 Gas Lou
obile Home replacement ❑ Roofing Q Sewer Line ❑ Pnoio-voltaic.
tine Q lNood/pellet Stove (must be EFIA-cerdned, -provide make,. model and
!sl
,I
n the application. Incomplete applicatinnc wrrn hill Sa
Applicatior #_ 15I50000-2,
I I.
pate
For cfnce use only.
I
-
30i; Site Address (requfri tb)
Value of construction (labor, materials
,prom;
Property Owner Name
Address city/state zip: p Phone 30,j
�� M
-i 3Com 5 i rn lx"LV i, Qc{ �L;(i S (0 g 6� (0Q85%oc>
Applicani, Name J Address Cfry/State
Zip Phone q-7(j
j �U�-00O
Cflntractor Address city/State
- 'Zip Phone
Contractor City or Ft. Collins Sales Tax
II::
sah_s(arnum5`rlsrequlradhyall con actor, Are you paying with yourt(rrI
account? [L'Yes p No
is this a residential or commerclai project? Residential 0 Commercial
ff residential, is it:-WSingle Family.D7 tached Q Condo/tokvnhome:(Rngie Tamil .attached) ❑ puprez
0 yiultifamily.(apartment) 0
Garage
Ir commercial, is -it! 0 Ban.{ 0 Bar Cl Church 0 Hotel/Motel Cl Medical ofnce� f] office 0 r�eiaif
0 Restaurant 1113 Other (explain) �
is d1is building 30 years of age or more? ❑ Yes ❑ No If Yes, yvri may nead to contact HistoriePreservation
if this is for a demoiit'ion permit, what.year was the building constructed7
If prior to 1975, you ivili need an asbesros assessment ro submit aritli this application:
Descriot.lon of work Rd`-�
sr '. L I,
;f Iawn. sprinkler/backio preventer, musl.ris.aLEns4 lumber. YT flrstAfm A/C, must lis licensed electrician..
eabcontractors: Lisccnecrmpanrnam1eolrCiyafFtCoHins/icense
;
Elerridan Plumber 1- (. �lechanirat Rao { — Z �S S Other
hereby acknowledge that_ havexead
comply VIM all requirements contalned
permit, is not Aialid until i:, has been
Applicant:
Print Nam
)p}ication and slate that -the above rnFormation:is complete and correct. !agree to
and city ordinances and skate laws regulating building construction. 'know ihaz a
and issued.
Signature
T
wa0965 @AURA /
,,a6Pa do-dod asodxa jaded paaJ i
o; Bull Guole PUBS
®091s aieldwal @fuany ash
slagel ®lead ilse3