HomeMy WebLinkAbout3123 Birmingham Ct - Applications/Reroof - 02/28/2018Clt'O Planning, Dei4lbpfnent & Transpow kiltion Services
rt $ communay Develoownt & NeIghbort ood Services
281 N&M Coilsge avenue
Fort Coulk CO BOM4 MOkL 9MA182740 ax; 970.2UA134
OVER-THE-COUNTER PERMITS O LY
This application Is to be used to apply for the following permits only (check all at apply). ❑ Air Conditioning
❑ Demolition (Interior non-structural) ❑ Electrical Alteration (not service change) ❑ Ughoer ❑ Gas Log
❑ Heating Unit ❑ Lawn SprUdder ❑ Mobile Home replacement ❑ Roofing ❑ Line ❑ Photo -voltaic
❑ Ventilation ❑ Wafer Heater ❑ Water Line 13 Wood/Pellet Stove (must be EPA tiled, provide make, model and
manufacturer).
Complete all appilcable information on the cation. Incomplete applications 1 not be accepted.
� . - h . �
lob Site Address (ragAva) Value of Consbriucil
an (labor, materials, p►oflt)
`Q 00
Property Owner Name Address City/State
ap phone
` 0
7 -aa - 03
Applicant Name Address Ctty/State
l
ap Phone
ap Phone
Coritrao or Address city/State
Contractor City of Ft ans Sales Tax # Are you paying taxes here or
3y report? 2 Here ❑ Report
y �br� �w+osctas Are you paying with your
account? 10 Yes ❑ No
Is this a residential or commercial project? ')BRestdentlal ❑ Commercial
If residential, Is rc Single Forty Detached 0 Condottowrdmme (single family atta
ed) 0 Duplex
❑ MuIfltamiy (apaftont) ❑ Garage
If commercial, Is rc ❑ Bank ❑ gar 17 Church ❑ Hotel/Motel ❑ Medw office ❑ C
Mee O Retail
❑ Restaurant Ci Other ( )
Is this building 5tl years of age or more? ❑ Yes No Day Dyes.. mneed to contact
c Agm2i PAw_ v8f w
If this Is for a demolition pemdt, what year was building consbW ed?
Desuiption of work
*If lawn /backilow preventer, must ust Ucensed plumber. If first-time A/C, must
1st licensed elecdidnn.
subcontractsrs. [.bt she cmrrpany name ar Qty of CaNks lkww of
Pk,mbv Roo er
otiw
I hereby actrrovrledge that I have read tuts applkatlon and state that the above information is camplele
and corral. I agree to
comply with all requirements ax t fined herein and city ordkwxxe and slate laws regulating bull
ling oorstrx lion. I know that a
pamit is not vadd unt! It has been paid and Issued.
Applloant (�
PrintNleme.�ni�►-t rirrnA,n Signature
Data 4 � LK