HomeMy WebLinkAbout2608 Canby Way - Applications/Reroof - 08/04/2011F OrICOW Collins
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Planning, DevelopMent & 1
281 N. College Ave P.O. Box
fbit Collins, CO 80524
Phone 970-4WZ740 Fax 22,
OV I ER=THE-C:OUNTER PERMITS ONLI
This application is to be used to apply foe. the faflowing pennits only (check aB that apply). I
* Demolition (interior non-structural) 0 Eledrical Afterstion (not sere 'go change) E3 Gas Lighter
* Heating unit b Lam Sprinkler E3 MONO Home relAacement erRoofino 0 Sewer Line Cl I
Q Vmftdon 0 Water Heater 13 Water Line 13 Wood/Paget Stow(must be EPA.cerflffe4 provi
manufacturer)
ComPkft A =01itable Information On the OPPOCRUOIL Incenudde applications wig not be
APPOCadon # Date.
ATr alwitiv 01my
Log
model and
lob Ske Addn�w�rs
Value of Construction (labor,
PRft)
Property Owner Name Addrew
MY/St ft Mro
Phone
Applicant Nwe Address
City/staft Zip
Phone
Corft=r Address
CRY/S�e ZIP
!Phone
Contractor Gty of R. Collins 4es Tax
MAr bYaFaftzd=
Are you paying Mm hem or by repoW
Are you paying with your trust account?
, yes,
polt
P
O
Is this a residential or commercial project? alkeddential 0 Commercial
If residwfda 'Ls it b 'Ie
-Tmg . RNTIBY Detached 13 Condo/Wwnhome (single family at!Wxed) 0
D Multhmily (apartment) D GarageIf conmerclai, is It d Bank 13 Bar D Church E-3 Hotel
10 Restaurant - 0 ImaW 0 NOW office 13 Ofte 0 Re
Is this builft 50 years of a" or stare? OM(alkt� ffvesr you May -nOW W conbct irzftk.4
If this is for a denidlitim peril, v*gt year was the building corsbUcied?
JVpkr to 1975,)4W wff iwgd an asi> asassafffileFt to -Qdil* Ndh dw
Of
V lawn spimider/bawim ivmwter, must rot acersAdownw. If &*-drne WC, mug list licensed dectrlcia6-
tm*a_ Othe'
Bectrida vm
I hereby ackroMed allm is cmnoft and cc�, -1. -1 W 1 ge that I have rod this application and stale that the above Wwm I agree to
Comply with all requirementsconWried herein and: city ordinances and sbft laws regulating bidlifing qndnctlI � Irowthat a
PON u-N. is not valid and it has been paid "d,::
Applimnb
Pdat Name-.Mc-j
nab -7T