HomeMy WebLinkAbout801 GALLUP RD - APPLICATIONS - 6/28/2013From Affordable Roofing Inc 1.970.207.0289 Fri Jun 28 10:42:59 2013 MST Page 2 of 2
\",.City of planting, Development S Transportation
s ' u 201 N, College Ave P.O. Box 580
,,
�ga M Rxt Collins, CO 80524
!� ,�, �,,�,...�`••"•"""•"^,. PtIOM970-416-2740 fax224-61M
OVER:'TH"OUNTER PERMITS ONLY
This application Into be pored to apply forth& following permits only (check all that apply)..0 AU Conditioning,
0 demolition (interior non•stirictcifal) 13 Elecuical Alteration (not sevice change)' ❑ Gas Lighter CI Cuss Log
0 Heating Unit 0 lawn Sprinkler 0 Mobile Nome replacement �[ Roofing 0 Sewer line 'O Phow-vormic
13 Ventilation ❑ Water Heater 0 Water Line O WoodlPellet Stove (must be. EPA certified, provide make, model and
manufacturer).
Complete all applicable Information on the application. Incomplete applications
I" beiaccepted.
MPI-rcation #�1 Date
%r oPTm:r ust', pay --
Sob Site Address. (re7a1t&y) Valpe of Construction (labor, mammals, p rlt)
Property owner Name Address Qty/SWb_ Zip phone
'-r`4l`-�----cvllb.,z------.._._fors:- ti.t rt,,�l,,�; S.>.i:_ F'(CcYU.t1� o;�r._ •. _.:
,Appticant Name Address citypWte Zip Phone 9 +W - i
a (i t.<): i-rt, C4 A6.�d S a a7-car. o
Contractor Address ty/State ZJp P Phone'
Corrtrdctor City of R. Collins Sales Tax. S Are yr,u paying taxes Here or by report? C).Here 0 Report i
sue• rarrarrtzr 9w>ettyr ctv form x Are you paying with your trust account? G Yes C. No
Is this a residential or mmmerdai project? W Residential O Commercial
It resitleirtial, is it: (H-Single Family oetached O Condo townhome (sirmgle tamilyatfarhed) Q Duplex
U r1lul famay (aparbnent) D Garage i
L carynercJat, is it: C7 tbrik 0 Bar O Church 0 H4tel/Matei O Medial otfice O OrNce 0 Retail
Q Restawant O Other (exPlauN
Fs this building Sit years ofago or more: O Yes ❑ Np Ifyaa, yrou r^ay rdxyl m'crurtdn FfxsClrk Prrarvarku+
if this is for a demolition permit, what year was Ore builoing corotrie3ed? ........_----
.fi prim N 19,75, ym w6//1reed sn asbesrus amessnoit te- 3uMNt AN'm. hfs app6c�Aon. .
D25o ipwrl of work
rYbnb'2t i': L, ,: i
; :l lawn spins,,/backhpiv Pmentex, must fist iicem" Pluttriicr, 'Ft firsAtptx: AIC, must asC Ptrrm!�cyl Wedrieiart.
subwntractorsr crsf me c mptarw roan er CdY Of c;a'urs &tense a.
SaMIr39r, ... ......._— r9urrtEl1 c:,o,:n a-- ........ w«'re' R = E y-S V ot;.
I hereby ackncwi dge that I have. rcdd this application and Sete Mat the abeve Infmnation is ournoete and conect. I. agree m
cemplywith at valubeir,enis-cantahmed herein rind city aMinanaxs and state laws regulating bulls ft constmxtlon. I knew that a
permit Is not w0dUntil It hiis been paid and Issued.
Print Name:...!:. �:'?. .,�.1�t4 hN l $ SignaWte:_....,_, �:';�:7 -----------