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Home My WebLink About6237 Southridge Greens Blvd - Applications/Reroof - 09/16/2011Sep.16. 2011 11:31AM ADVANCED ROOFING No.1502 P. 1/1 City of Planning, Development & Transportation 281 N, College Ave P.O. Box 580 F©r$ Collins Fort Collins, CO 80524 / Phone 970-416-2740 Fax 224-6134 OVER-THE-COUNTER PERMITS ONLY This application is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning ❑ Demolition (interior non-structural) ❑ Eiectrical Alteration (not service change) CT Gas Lighter C Gas Log ❑ Heating Unit ❑ Lawn Sperkler L Mobile Home replacement G Rocfing Q Sewer Line G Photo -voltaic Q Ventilation G Water Heater Q Water Lne ❑ WcodiPeilet Stcve (must be EPA certified, provide make; model and manufacturer).. Complete all applicable information on the application, Incomplete applica ' s w)illll not tie accepted. Application a 1(y 7--5(3 Date�(U�l For office use only 3cb Site Address 6R3-jJbajLhcQ2 G'r�en &Iwo I Value Of Consttvcaon (labor, ma_a:^:e[s, pro -fit) 1 $rl S Property Owner Name A-444 42Q37 �l Address Cib//Srte Zp ��L'i1 S�IUYJ ///L� 8DL S Phone C/70 ov `i 6 Applicant Name A dress Gt(/State �o . Phone gio �}OV PrNC�`D Qoe►ng I�C'hnOlc��s 44c-lc� hers pre W lndsp r Co 8dS5o 663-6a0 Contacr Lc m Address City/sL"=tz zip Phone E)Acko EQdj1s - ConL toter City of Ft Collins Sales Tax # 571eSOx Are you paying taxes here or by report? ❑ Here Ar: with trust, account? � Q Report ❑ No A9aS(D you paying your Is this a residential or cc real projer? I`ite=_idential Q Ccmmerdal if residential, is it: ET Single Family De�=hed D plex ❑ Multifamily (apartment) 0 Garage If commerrlal, is it: ❑ Bank ❑ Bar ❑ Church ❑ HctzVNIctal ❑ MediQl efj;ca ❑ Crce ❑ Retail ❑ Restzurant ❑ otter (explain Is this building SO years of age or mere? ❑ Yes �Olf s,ney5o convectI st cc Prser-iarren If this is ,`cr a demolition permit, what year was the building constructed? zpr,'er cb 1975, you mil ne_d an asbestos assessment to submit with this 8pp/ic2ccn. of *If lawn spenkier/bac.ecw prevent=-r, must lisp licensed plumber. If first-4rle A/c, must list iicansad eiertridar. subcontractors: Lsttheccr,-panyrenecrCt/cfFCo/lirsAcense 0 Me�zgiczl Rccf2r Ct:,er EeC7idar P!urrcer. I hereby ad<nowle-ge that I have read LNs applic=Hen anc state the' the accve inforlatcri is complete and tarred. I agree to comply with all requimments contained herein and cty ordirarces and scat' -.laws rezulaune build-inc ccrstructor,. I know the; a permit is not valid until it has been paid and issued. Applicant: / I� n ela eelj J Print Name: � 'Sigma, � � Dzte 7 1 Q.