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HomeMy WebLinkAbout1719 Pecan St - Applications/Reroof - 10/03/201610/03/2016 11:02 19702241211 ROCKY MTN ROOFERS PAGE 01/01 Plannhm% fD� & Transpett#olir�n �w` Y 261 N. College Ave P.O. SM Fort Collins, OD BOS24 Phone 970-416-2740 Fax 22+ 134 0 R-THE-COUNTER PERMITS ONLY This appikatlan is to by Ib apply for the following p�ft only (dw* all that apply). © Air Conditioning 13 Demothton (mtedor ) 0 Cled taai Aftemdon (not =vice change) O Gas L. ghhw 13 Gas Log ❑ Heating Unit 0 Lawn S ider O Mobile Home replacement KIoafin® 13 Sewer Una 13 Photo-voWc 0 Ventilation CI Water Heat 13 Water Line 0 WaodlPeW Stove (most be EPA cenMnd. provide make, model and manufarkurer). Complete all appltealsle t/n� n,n �(oon(/n tine appticadonr Incomplete appii{rtx�tiens will not be accepted. L+� raw ll Property Owner Name Adddr(\�es11s�CityISUM ziip. Phoonelq Q Applicant Name Address city/swft Zip Ph" -1 3 Address QW/ Zip R"Ur�.�a [�ca C > rr . — i z.Cap ConVacbDr City of FL CDHIng Sales Tax 14134-(o Are you paying taxes here or by report? 0 Here It Report ,Ww2wnwjk ri9fi* Wbr a atJtYs. Am you paying with your Vust ac=mt? 43 Yes Q No Is this a reslderitie) or prpject? 0 Residential 0 Qrnmerdal If reside nwii, Is If~ Cl Sdn Fanrlly DeW)ed C7 Cerrdo/townhome (single family a&3&md) i Duplex 0 W (apartment) 0 Garage If eomnerdai, is it: 0 I9a CI fir l7 Ctwrdn 0 Hobel/Mobd 17 Medical office Q Ofiroa CI R,etall C] want Ci Omer (ercpiaNr) r,.- -- - IS this bum" so yes of or enmore? Q Y� No ffJe, you meynned m MEcGp►icArvr! If this is for a dM"M what year was the bud ft corms e.11) ffArAr It? x97r, yvu 78 os asae rant tv StAd►r�t' w i dfits 'KIf fawn sgxinkler/backfl0w I hoeby adi wiedoe that I comply with all requirements PO is mt valid and It tarint Hama: O W, moat fist gamsed plumber. If first-time AfC, must list 1 n dectridan. .rare Araryc+fftQa�rx; � Yk�v�►�st�.►�� � Medw *A _ . _____ _ (loafer other read ttfs appou" and state that rtre Wme lnfq melon Is complet and oorrt I agree to shred herein and city ordirwrice5 and state him regLdM g buAdbr9 aortsbrucW. I larortrr drat a biea Paid end bound. a ftwtum Dame jQ •� .�(p