HomeMy WebLinkAbout443 W Troutman Pkwy - Applications/Reroof - 09/17/2014This application to to be used to apply for the following permits only (Check all that apply). 0 Air Condjtioning
u Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler O Mobile Home replacement Rooft ❑ Sewer Line ❑ Photo-voltolo
rl kleniriaiion 0 Waier Haawr ❑ Wate_r Line i? sllloud/PeRei five (must be EPA ceroned, provide make, model and
rnanuiacturer).
Co etie all 4 lto a Inigrrnetion on ffia application. Incomplete npp0oationo will not be acospbwd_
ti Date
o usr only
I job Sft Address (&quired) Value of Construction (labor, materials, praflt)
II it71- t. � s b
Property Owner Name Address city/state ZIP T- Phone
Applicant Name Address City/srate �~ Zip Phone Cj W AJi6sAmUe Tr'.00 2 at'1 tJ. T tb CLrp Pm Co $OSa,< tea'--odoa
ConlrzMr Address ty/State Zip Phone
Cunaaclor Qty of Ft. Collins Sales Tax iV
Sales trx,wrnGrr a`rrAnrrrd Jyatl rnnlracYoh.
Are you paying taxes here or by resort? 15 yere L7 Repnrt
Are you paying with your bust account? gryes D No
is this a resfdenbol or mmmordai pmlect? @i Residenttel Q CommemTn1
if residential, Is It. ;I Single Family oet-adied G Condo/townhome (single family attached) CI Duplex
❑ Multifamily (apartment) ❑ Garage
I; uuminarcNI, is iL: ❑ Bank ❑ Bar ❑ Church ❑ MoWlMotel ❑ hledical offlw ❑ Offfce ❑ iietall
❑ Restaurant 13 Other (explain)
is this building SO years of ape or morel 13Yes Oft lrye* you may need iv coniuctHmirkPres"ffarr
is this is for a demolition permit, whatyear was thebuilding eonsWavdP-
If�rias to 197S, you wNU nmd an asbas Ahls oppk ,66n.
0escriptiori of work_ car a4-C- i- r:fA!e5r-e 2-.i rj(r9hq r»o-r .0
,4f lawn spdrilderlbaddlow preventer, must list licensed plumber. It flTbitAlme AIC, must i19 licensed electrician.
sub contra-ctnrs: r!sl thernmpvey nE�mearC7�yarJYQdllns/ham�
Jectfdar
rneoallo1 Roofer ?,- 1 0 59 Other
i hereby acknowledge that I have read this awllciftn and state that the above information 1s cvmplats and correct r agreB to
comply with ail req,rinamsnk4 contained herein and dty ordinances and i ah! laws MgUlatfng building oonetruetfon. a know that a
permit is not valid until it has been paid and issued.
Applicant: 1 �r-- 4 ' r -5, Date. l
Print Name: Ay"Lk �! t�hyt i tnQ 5 Signatutc
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