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HomeMy WebLinkAbout604 DUKE LN - APPLICATIONS - 11/12/201311/12/2013 12:21 19702241211 ROCKY MTN ROOFERS PAGE 01/01 Of Catins IPhr ft% DeveoWamowt Bc Tmusportation 281 N. OAege Ave P.O. Sax 580 Fork Cyr CO 88524 Rolle 970 416-z741) FaX 224-6134 This M*Mpation is to be used to 41pply fos the i 1wRin9 parmits only (check all If%A appty� ❑ Air ConMoning Q DerwfiWn (wsrtar non q . U Electrical Allazation (not service change) 0Gas Lighter ❑ Gas Log © "eating Unit 0 Lawn Sprinkler CI Mobile Hair repfaoemo t eig 17 Sewer Line 0 Phat)-uoitalc ❑ VentikMon Q Water Heater 0 Ulater Line Q Wood/Pellet Stove (must be EPA certified, provide make, model and marhularttrrer). Complete all applicable k ornrat$xi on the gpiicalion. hummptetr: applications will not be accepted. Appikaffon * 1 t305957 Date FbrVfAw&wVwy ?ob Sfibe edam (ra g&ad) Value of Gumtxuction (labor, mat a iak profit) 0 $ CAnr Name Address l� QW/Staw Tip Phone a" q� — Mqk m Applicant Name Address C ILY/Sbde Zip Phone Contractor LIC FV3Ad*ess >"d CK=,- Yr)ov'n�i r+ ,t _ City/State Tip Phone q-10 Contactor City of Ft. Cd ins Sales Tax # L4 j 7JnU_I. Sala tarrxenGogrlsl Gyati[>A�QarAz� Are Vou Paying toces here or by report? O Herr• Jt Report Are You paying hroM ycw but ara m mt? )d Yes 0 No IS dus a residential or commercial prnjed7 I Q Cnrrerierdal If ieSklelhG6l, is It 0Surgle fertn-ly D Gondo/tawnf wme (51rxft fan* atteied) Q buplbx MuM_ftW(alwtmenQ © Garage if aw meriial, is it E3 Bank tl Bar Q Church C1 ma"MOW ❑ Miedk aff'ioe © Cmm ❑ Retail © Restaurant 13 C)tiier (expbin) Is this bui ding 50 years of age or mx e? Dyes rfy yrw ma}' d irl mvrbd h is If this is for a denv* ion per rzifl , what year was the Wending conspuc W Ifptbrtoml-5,you*wnoEdan, I 9betas w_rdarrut"WA*awARUA z an *If raven sprinider/badtflow preverw, must fist aamwd plumber- 1f,ast ljme A/C; mhat 0St icen5W . SubcoroxeCbom List MecwwaVawe ora. ,ofa�CNMNffaffN., �� M�harBcal Roofer Qtlta _ I hereW admowledge thaat I Beira read tiffs appbcahm and State that the above irttbUni On is Cwq&le aced correm I aagree bo comply with all rh rns opined bereln area cagy ordnmxw and slate laws reyL"ng tnrla&ng construction. I kmaw that a perndt is not va0d holm rt has been paid and issued. APPRCMIL- -wi Data % % I I Z113 Mrus`T KC.t. mn+