Loading...
HomeMy WebLinkAbout3624 Arctic Fox Dr - Applications/Reroof - 03/10/20153/10/2015 1:01 PM FROM: 9702081701 TO: +19702246134 P .: d Plana, Deveknmwnd g 281 W. Cofte Ave P.O. Box 5go Fort COMM, CO 80524 Phone 970-416-2740 Fax 224-6134 0WRowTH&COUNTER PERMITS ONLY This. applicadon to to be used to apply for the fOilowb g permits only (etceck all that apply). ❑ Air Condi oning O Demoiition (interior non-shictural) 0 Electrical Alteration (not service change) E) Gas Lighter 0 Gas Log ❑ Heating Unit ® Lawn Sprinkler ❑ AAabile Home replacement ❑ Roo" © Sewer line 0 Ph ato-voltaic O Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, nodef wW manufacturer), Complete all applicable tnformatlon on time application. l wAmID109 aPPftabNm will rmot be . ®ate rD 0(:> lbb Site Address t/ L+1f GL) Value of Consbuction (kb , mates i✓ ts, prof ) Property Owner Name Address wStabe Zip Phone —7 ie' . A J �/Stxe Zip Phone pntntarre l� .lou.�S 210 0s"3 c Address clty Zip Plane (V) 2SS s Aq ^3-7 2lg r 7oS3 ContrW" City of Ft CoMbis Sates Tax ,# Are youpaytng taxes twre or by report? JErHere❑ Report &9W 4ar Indribff & AMXAed by ad C&*Ve4xm Are you paytrmg with yaa bust account? PEYes 0 No If Ade t w .w Farnity Detactxd • CxWoAwmhorne sr n _ a :nr: r..W ■ DUPICK ■M1&:RI':0 I ■Garage ■ Resuwant ■: O.. w :...v... If this Is •: .: nto b.S.nx a fa - r -. rf... •..♦onst ,.Icy If :'I• h !• N nO need &7 a5basWS a2MMP09 to . Yt ie`. a•:( f.T.... .r'� L 4 q M7 tm� S••"s L L.r t^.=/1' %arti a•' .. . ,r. ,;;:.-.,.- a _.,. r .. :. r,r Vw:r. •: .r -,r e.- ;arw. .. , .. • .n-•. :., •• .. ^..- ... •r, e• .... I• -_ •. ..- . .q .. § Cs (r .:. ,::.c cr, rr.. .a.. o ".r. a . .•'.. • n'. :� •-' :r .. -rr.• r. -.�- AppUceaLz �" Print Warne ✓I ,rr 1,�i1 ; /✓�l ✓wV Date. �%