HomeMy WebLinkAbout4107 WAYNESBORO CT - APPLICATIONS - 9/16/2014This appliaskion is to be used to apply for the Paliowing. permits only'(chetsk all,that apply) O Ali Condluontrlg. 1 -
O Demolition (interior non-structural) O ElecM Aitelation (tictservice: change) ❑ Gas Ughter t Gas'Log
0 Heating Unit 0 Lawn Sprinkler O.Mobffe Home replacement 6 Rooting i7 Sewer line - O Photo-voftWC',
Q Veniiiauon 'E1 W_,ier Hea1er,D Voter Une U WoadlPelet Stave,(mustbe EpKeertiite6, piWde roela , ro'del and"':
manufacturer).
IC brnple ap tca i a o aD h n..;IncomDiet®apasiioationa voilinot be'accepf�xt_
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Far aea use only
Ioit Site Address (regita7)
..Value cif Constructioh (labor; rh Otte l r PWftt+}`
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Properb/ owner Name
Address City/State Zip
Phone
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Contactor
Address; /sia zip
Phone
Contraotr r City aP,F?t; Collins Sties Tax lir2,ypu paying taxes here orby n�art?' ua
P Report
Salrsternumlurls+eoulralbyeb =MUM �
Are You paYln9,tivO your trust acm inn: 'Yes
0 No'•
.Is this o rc E idenhtai or commerdat pmlectg • Er Resldentlat Q Clommem iai
if reddenttal, is It .'[I Single Pamity Datarhed ' Q CxwoltOwnhGme (single family aftched) Q DLVex-
13 Multifamily C;9* ment). P Garage
If commwQw,•is iL :0 Bank 0 8ar O church- 0 tiotel/1,16 l O Medical aBtce Q Office ."C1 Beloit
0 Restaurant Q.0ther (explain)
Is this;buildlnB i5O vears of age or, mom? O Yes 13116 ifi4 yourhay tD=nt2 ctHtst fc�n�atidif.,
If this is fora deswortton jidvuit, whatybir was &&,building con6tnrfed?-
Ifpiiar�Y975,y0uw111i1a�'8n,ssl�ssmsas�e�n�sntQssubmirucdi"driSappyrc83at. " 1
oescriptioii
sir lawn sprinkler/baddlotiv preVenter, must list Ilcmsed ptui r. If fiiStiWme'N4,mustilst QcenW
SisiiwAir_atmrs: LwI iewmWnynanh-a-GHyofItQz&skar ig
EJedripa� Piumbee_ McCbBnkzL . Roofer R" 1 `; Sg: • 'affiei'
.Y her xdmrnyledge that i have. read this appl�tion,and slate that.theatiove'U
CompryilVith all requirements coined herein aivd i lyl ordlnanos and state laws
permit is not valid untii:it has been pmfd and issued.
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