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HomeMy WebLinkAbout140 Pearl St - Applications/Reroof - 09/28/2017Planning, Development H Transportation City of :81 11, CrI;ege Ave P,Q fink SSO ,Fort Collins rrrt Ccrlii:1%' cry $0524 Pnor:r <,t7() 41 G 74f3 ra .1.24 6134 S OVER-THE-COUNTER PERMITS ONLY This application Is to be used to apply for the following permits only )check all that apply). 0 Au Condibtining C1 Grnttii;tion liau:rior 11ran•slnuaur t1) U Ciechi „,I Ntoixioti (not sorvico chenau) U Gas Ugh;ar U Gas L xl E i Ns sting Unit 0 Lawn Sprinkler ( ;° Mobile Nome rupfart;to •ai fWfloofmij ("I Sewer L'od is Pholn-voila G :3 Vr:nt `F'Uo•`f 1:3 Water i4r,37pr LJ 4Vat,_r line tei 4M1't✓.,dM(;drt S:om tm:t :t t•t! EPA s:•�rtifiec+ tur'n+uX4• mai.t, mode; ziltzt mitr.WOVIOUT) Complete all applicable information on the applicalion. Incomplete applications will not be accepted Application # �i 1� v v Bale Job Site ,AGQ�'Q,ress : k�Frvrr ~- -- ~, L Value M Construction ,Intro+ r t..ttt tie: prdtitf MopertyGivnef Name AdifIr-xi CltvjStatrs Zip phone , Z? ZSrYa�� rho'/ , �c rv/.; . lvj � z� Applivaant Nome Addrry^I clly/Mate Zip phone ..SC'}'�"6'h. ` .f'P . ?`.a r -�s✓' _ `�`✓ t:n11VaClCu Addre.,;% .'.ip PPhone . �2' Contractor City of Ft. ColIA'sa:er Tax e, Are you paying tam sere ar 5y retort? C1 Here .W-Repotl ceaCf far nun.x-rs mrurr itl ,rs svt ..van Are vote paying Will yaur trust account' 13 Yes �EJ tin F:eomcr -ides lot tx cwmnert(a1 projertr Y3 krsiticrtUat OIitr )P'yingtt Family Detached 0 Condoltryvinnomt ismg'e fam+;y attorkeri) Ci Dupre.:❑ MuitiNinity (apartment` O u.trage cial,isit: 13 Bank 0Bar 13 C.huich Ofintellf,tolet ClMctjicalofRcc Clciflce ORetall © Restaurant C) Gthty (vAplan) • . - - _ . LS rJUs litillcfrttl SD years of age or r11CNe* Q 1ef1r1t) /(}$q. IYh! Ilia. `t�;N?tr fi') [,"uthSLf ,L1t5ifR Intt'Sttflil#,'ml I(th`s Is for a demolition permit, what yrzirvzasAe Wilding coast/titled' f% pram to 1 IS, / u trttl rt Ys! en rr5brs io> ri.st Sutr„r; tc subm,' ., ty !n:i 11escrlplltlti of work ' 1f 4iWn scut: tth7s(tt;tCkftnx• Va�`�tntt.:, rtu>S ttsi [ ccnr�:d plutaixr. 14 ht�,� �rttl t1C tru3i Sat I:e��tse�L1 r,�c^_ttturtt ; Subcontraetorsi t,rcf rhe, arrilnonY ihvne tv OryiW l-1 t_ttt:.r71:u'M1as� u' 1 Lt_'rttiu.rtl�„_ _ _ � _. r'Utp!>.•- _ t h ,d- 4Jtt �/�/ �V .11C! I 1 tlti it R+'--'�}'�'t'�YC ltV �`t IlaVs TLSf' Lh;3 ap,l{fdLf3.fi sett' l).L` 1h�1 Ear' 4MyY ttdCt'T 3I.,CSt S i"»}'Tl`1•'C;•_' at!'i C,1.TCf' 1 RrjrL`F tU 6` Etj (.0mgly •rtii aU tuquaernc'ms lcutid1i1EV hL.lrtr-n artU qrd n,'w-, G AIW la.,,. ,e'qulittiq tr-,balm, coitWvvt-u' t know that a permit is not valid until it has been paid and issued. Applicant: /„ -' �• Print Name �;{mac ��t ` �> Signature ' Date,