HomeMy WebLinkAbout1257 Belleview Dr - Applications/Reroof - 10/27/2014Thia application is to be used to apply for the following permits only (check all that apply). 0 Air Condmoning
Cl Demolition (Interior non-st;ucturai) ❑ Electrical Aitetatlon (notsetvIce change) la Gas Llghier 13 Cos Log
Ct Ideating Unit 13 Lawn Sprinkler Cl Mobile Home replacement IE1 Roofrng O Sewer Line 13 Photo -voltaic
i1 Ventilation ri inl_ter itiezier R water Llne (mustbe IPA cediined, provide mom, modei and
manufacturer).
CemAlete ail applicable Infnrmatlon on the application. Incomplete applfcatkons will not toe aacepted.
Application * F31q l O& q 2 Date 0- Z �7 -19
Forafice use only
Job Site Address (,WUIr9tIJ
Value-' of construction (labor, materials, prout)
E 1g 5 -7 Ij
0 Lj
amperty Owner Name 112vifAnl Addrm
ctz/Siate Zip
Phone
e l � N&I 0 -,,
IS AIM C 1-1 Fro - �2 q 0
- q3 7 iy
Applicant Name ddt
City/StateZIP
Phone ¢ 76-
A��� ruble 'Pala-r:�W , :L Inc . a In
u. 'C-6 ter" Cza I='i ;` c6 rasa S
Contmdcor J Address
Ity/Sia"re Zip
Phone
1 C.ontractor City a=%. Callins Sales Tax
Hre you paying taxes here ar• by report? M$era
Cd Report
saw
i
Are you paying wlth your trust account? Eryes
is No
is this a rPsidentiai or commercial pmjecV gResidantiat Q cemmmI al
li residential, is ]t. 0 Single Family Detached U Condel�3iwheme (single Family attached) 0 Duplex
b Multifamily (apartment) CI Garage
V commercial, is it: IS Bank ❑ Bar Q Church Q HubaVMaiai 13 Medical office ❑ Oi-nce Q Retail
0 Reswurant C[ Other O=Iahi)
Is ;tits building 5o yeats of age ar more? O Yes OW T yam, yoy maynead to contnrr HI_;W c arasaroanbn
tr this is Ior a demob:ion pezridy labatyear was the•bullding conwuc� d?i
I: priar<b f97s,, you rW appAmeon.
of
*If fawn wdrillerlbackilaw prevanter, must list licensed plumber. If hrst time Alq must list licerned ele-Cmdarr_
Subrontraetora: °tihecnmpanyrr3rneorGyo�Fl CbAlnsllcensa
Flecydan^ Number Roofer R- LT93 Other
ilemby ac[mawledga ihai:I have read this appikehlon and state that the above irtrormnton is complete and mtred'. I agree to
can, ply with au raquirements contained herein and c1ty orriinaTUMS and state laws Mulating building tonstruciian. I knowthatm
pemiftt a not valid until it has been paid and issued.
Applicant:
Print Elam