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HomeMy WebLinkAbout1043 Deer Creek Ln - Applications/Reroof - 03/18/201503/16/2015 10:17 19 1211 ROCKY MTN ROOFERS PAGE 01/01 tcyfC otti s OVER This application is to be uN d io Demolition (Interior non-structur 0 Heating Unit ❑ Lawn Sprinkler 0 Ventilation 0 Water Heater 17 manufacturer), Complete all applicable informal Application # b-60 Z For offnae uae only Planning, Development &Trartsportatlon 281 N. College Ave P.O. Box 580 Fort Collins, CO 80524 Phone 9711-416.2740 Fax 224-6134 PERMITS ONLY Ipply for the folWng penNte only (check all that apply). ❑ Air Conditioning D ❑ Electrical Alteration (not service change) Cl Gras Lighter 13 Gas Log ❑ Mobile Home replacement KRwfing ❑ Sewer Une ❑ Photo -voltaic Vater Une ❑ WoodfPsliet Stove (must be EPA Certified, provide make, model and on the agplibeUon. incomplete appricattons will not be accepted. Date 5 . \ g • DO15 lob Site Address &mukaV Value of ConsbuMen. (labor, materials, profit) D. �::.. Property Owner Name Address city/Stain Zip Phone q 40 MtXw StM . l 3 h'Aa4- Cry L „L L c If HOD' Applicant Name Address City/state Zip Phone Contractor Address city/stale zip PIgne4-14 Rwax" vv.o u—Mo; a• 6 (�,.ut4tiorS S-I.aje--"*'Wd Contractor City of Ft. Collins Sales Tax # L115 -T(o Are You paying taxes here or by report? •❑ Here lk Report _QWM &w jumobff &mqubvdbyaa aVWR M Are you paying with, your trust sccount? 4l Yes 0 No is this a•resldential or commercial p ojert7 Wesidential ❑ Commercial If residential, is it: 0. Single Fam ty Detached 0 Condo/townhome (single family attached) 0 Duplex C] Multifamily apartment) 13 Garage If Commercial, is lt: 0 Bank E3 E 3r 0 Church ❑,Hotel/Motel ❑ Medical office 0 Office ❑ Retail C] Restaurant © Other (explain) Is this building So years of age or more? ❑ Yes ❑ No If yayyou mayneed m cnnhiet HL4&v C P►�vaAw If this is flor a demolition permit, at year was the building constructed? Ifpiw to 1975, ynu w#rAsed an assibestas apt to subm/tWO this application. of Work *If lawn sprinkler/baddlow prevente Subcontractors. List he coMmilY mech iclan I hereby acknowledge that I have comply with all requirements aunt permit la not valid until it imm •palICBRb Print Name: must list licensed plumber. If first-time A/C, must fist licensed electrician. me cr QyofRCv11h2F WSe ,f V\kVC&r 4—\ LL'I- Med=kai Roofer other this application and state that the above Information is complete and correct. I agree to herein andcity ordinanom and state taws regulating building construction. I 1mcrw.tlnait a i paid and Issued. S;gmftm Date 3 -�S - aoti,�a --i-;-tc� IAc 4t� Ar