HomeMy WebLinkAbout806 SHORE PINE CT - APPLICATIONS - 6/7/2017'ci
1-gort of
Pletralllgr Vwdlopment & Transportation
281 N. College Ave • P.O. Box 580
Fort.Colliris, Co 80524
Phone 97G416-2740 Fax 224-604
OVER-THEmQOUfflMft PERMS ONLY
This application Is to be used to a0lif to!' Ithk fbgOMlU pew 9* hsqk all #Iat apply). 0 Air Comiltioning
o Demolition Untedor non..abuc3ureij 13 Eiecpicat %UteLighter
or, (rat sWog change) 0 Gas O Gas Log
<ee Badng Untt ❑ Lawn SprfnNer o ftfli Home re�lecemer►t o Roofing O Sewer Line ❑ Photo-voltsic
o Ventllptlon ❑ Water Heater o Water Lble o INoodIE'eeat Stove (must be EPA certified, provide make, model and
manufactiiA.
Complete all applicable Information on the applicatlom Incomplete aullcatfons will not be accepted.
Applicatlon I T V✓ V Dais
ISbrmtrrP tl� cvrlY
Job Site Address (n?qd".. Valera of Con's McUon (labgr, mabartals, prol10
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property owner Name Address Ctly/State Zip Phone
15 —
Applicant IVam' Ad oity/Slate 23p Phone
, a ZIP Phone
conact Adder -41
co Zdf
tat
ing sales TBx 'Ara yQU faj�$ here or by, rciSort'i o Here 7�fte)ort
P q�u0e� Ai' y� PSN!r3 w* your tru t aaoount? �'es l7 No
J�iliSf EL11 •� i9ro GYeUmn6'BaAus
is" it n ldentlal or 4�rnfn l 04 ed§ GKQd?ntf;l 4 Commence!
if residend3l, Is It I].iillble Family, bochgd ❑ Con�ojtownhome (singlefamoy attached) 0 Duplex
❑ Mutt kr* (apaitmant) a 6100e :
If commercial, Is It: ❑ Bank ❑ @a'r 13 Church 13 HoQlwlobel ❑ Medical office I] Office ❑ Retail
i3 Restaurant ❑ Cthg' fex , fin)
is this building sp years.pf age or more? M Ye5 , tqo Ifyesy ytw copyread io mntad HLslvrlcPrsa��va(/on
if this is Mi a demoiRl4n permient, whgt year vras tfhe byilding b4
jts
tfprforin 1975, gnu wtl/ nee�aa6e�esa�sinenl G� dvDinlf A�idi tSlsaPP���
Desalption of work 1
*If lawn Vdrdder/beeldiow prevenber, must list Rearmed plumber. If first-b= AIC, must Ust licensed electrician.
Subeontraeborsr W the cwnpenyname OrOgvofRCaDvAbm" #
E7oetrldml_ Mir Mrrfianl _ Roofer Other
I hereby admowledge that I have read this application and slate that the above Irifonnatfon Is complete and correct I agree to
comply wfth all requirements contained herein and city ordinances and state laws regulating buitling eonsWCfon. I know that a
permit Is not valid rmtll It has been paid and Issued.
Apprlrant Pwml+.1
Print Name f =Y1�"AoGj
,