HomeMy WebLinkAbout1009 E Lake St - Applications/Reroof - 02/07/2012Feb. 1. 2012 2:39PM ADVANCED ROOFING No•3442 P- 1/1
Planning, Development & Transportation
City, of 281 N. Colle�e Ave P,o. sox Sao
F6t Collins Fort Coilins, Co 80524
Phona 970-415-2740 =ax 22'-5134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used tc apply `or the fcilowing permits only (check all that apply). C Air Conti kicrr;ng
Ei .rremelltlon (interior non-stru=ral) ❑ ;lectrical Aitaration (not aervice chance) L' Gas Lighter Gas Log
Heating Unit C Lawn-prinkler ❑ Mccile Home ;aplacenert �ng ❑Sewer Line photo voltaic
❑ VenSlaton ❑ Water i aater ❑ Water Line ❑ Wood/P=_ilet Stove (must be -EPA cerifiec, provide make; model and
n8nJaciurer).
Complete all applicable information on t5e a--pllcaticn. Incorplete applic2tlons will not be accepted.
Application •L $Iao lS __ Dace �-7l�-
,�-*or oFicR rse only
*an (latof rnatenais prcf!t)
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Prope.`y Owrer Nzme
Tip
Phone
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Name
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Phone -70
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Ccnt-ac�cr UC Ad -dress
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Cont`actcr C•ty of ; t. Collins 5zies Tax ;t
Ara you paying 'taxes hera or by report?
O Hera ❑ Reror.
c�/s�xnun�e�s.�uiraccya/rmnY�cr.
Are ycu paying with your t-s ac_ourt?
Py_s ❑ No
�cf051�
Is to is a residential or commerdal project? Residentzl ❑ Ccmrnerdzl
If residental is ft Single Family Detached ' ❑ C3nd6/tewnhone (Slncle r=-mily 2ttac ed) n Duplex
❑ Multfamily (apat�QLI ent) ❑ Garge
If commercai, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hcte!/Motel ❑ Medical cmce ❑ Orice G Re�i1
O Resturant ❑ Other (explain)
Is this building 50 years of age or mere? ❑ yes �Ne Ifyes, ycu _Dn:=c�m,I.= Nc?;eserrGcr.
If this is for a demolition permit, whet year was the building Coast, Iced?
Ifpricr to 1975, you will ney'?r, ashes cs z�se_<snert tc suBmit wti5 t;Js �Fp��tcn.
of work
*I` izwn sprfker/b2cclew pr2ventar, mu_r list licensed piumcer. If nicnCti fie A/C, r,,US Ili, ilcersed elec":C?an.
5 L1OCDn.TaC:C^s: LS G ie CGr}cry i.crE Gr C1tl Gr ri G✓ll!%i5 /IC=rSe .=
ce, idar• ?!urce e apical RocP: i Oti,er
I here:y.2dc1ew!e-4ge fiat 1 ha`i-e read d its zp, iiczt!cn 2rd state �Ul at tie 2tcve inforrnaticn Is comp`_', End corree . 1 agree to
Comply WNI.all raquiremert5 [on"�Cined hareir, 2Gd GC/ crdlnancEs and stEta 2ws re lE ir:c toil( ing Ccn_°uu�Jon. I knOW that a
permit is not valid unt.1 it has been paid and iss
i
Applicant: �,,(
Print Name:�'i'1(�iNJo_���-fir _Sign2tu��1 \�Il{;_� r\yli� D2t,
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