HomeMy WebLinkAbout731 Laporte Ave - Applications/Reroof - 06/05/2012 (2)Jun. 5, 2012 4:17PM ADVANCED ROOFING No•4515 P. 1/1
Lit f Planning, Development & Transportation
Y O2Ri. N. College .Ave P.O, Sex 580
Flirt Collins Fort Coilins, CC 50524
r� Phone 970-416-2740 Fax 2z4-oi3?
OVER-THE-COUNTER PERMITS ONLY
This application !s to be used to apply for the following permits only (check ail that apply). ❑ Air Conditioning
01 Demolition (interior non-structural) il Electrical Alteration (not service change) r Gas Lighter E5 Gas Ldg
G Heating Unit ❑ Lzvm Sprnkler C. Mobile rliorne repiacemert �FARocfing ❑ Sewer Line Oj Flhoto-voltaic
L Ventilation V Neer Heater ❑ Water rl ocd/PeI!etctove (must be ==?cartis-len, Nrovidemnaka, model and
manufacturer).
Complete all applica',le innfflormmation on the application. Incomplete applicatio ss Will not be accepted.
Apoiicarcn � . F1 OLU ��`1 Data cf� ��
For ofrme !se ,only
�ob a to SrSiY{rne5 jicyQ,ti71%� �S6::i� ::i i.Q� i�'L° .I�i: (12t'^vr, r tc.':25, Croflt)
Property Owner Name
Address City/Si;te Zip
Phone
Ph r4-731 42IX4
t7LE0(b 60591 Q70(07
App icart Name
C1V//St3te Zip
phone q70
i� �,f�� hn.c5 gle_s
W46 6?rr f Dr .n4 C. WirUwr CO &)Sa)
6LOL-�-C&703
Conti aCor Lit tt
P.CGr2ss Ciro Stet=_ '_ib
?hone
�14Mrne.
Ccnt a-c or City of ; :. Collins Sais Tax # Are you paying taxes here or ay report? ❑ Here
0 Raper`
seles pxnarD ris,eaurreby60=M_V orr
Are y0L' Nc/lng with your mus, CG Jl'rL? pllY:S
Cl No
a�osto
is tiis a residential or cgrmereal projec-? �kRssident al ❑ Commerjal
_.d
V. residential, s 5ingle Family Detached' ed CJ Condo/townhome (atncle fZmIIV a eCr e )
❑ Mult ti miiy. (apdCu enL) Q Garage
If czimmerd2l, is it: ❑.^Bank ❑ BL2r ❑ Church ❑ Hote!/Motel ❑ Medlmi of ca ❑ Cffn e
L-1 Duplex'
.❑ Retail
D RasLur=nt ❑ Other (s)viain)
Is this building 50 years of age or more? ❑ yest tic rf yes, ycu mayneed_to contgcl',,.ka c ?reserrad'on
if this is for a demolition permit, what year was the building const*used?
if p,-y& to 1975, you will need an asbestas assessme ,t ro submit wry 4is epplicaticn.
of work .Kernove I�°t >� �_ 6- _ -exl
'cif [2wn SNrtitl'k'2.'/bacG1cw ariventFr, mess, list licEnse? plum es. If nrs— me A/G, host li„ ilCeru"2d e!e "reran.
Subcontractors: List b^e core pang name er Gty of Ft Collins dcense ._
Mtt:`aniczi Rc0`=r �_' `�-�' 7 Other
Zectn'dar. Plumb-,.
I hereby 2d 710 !edee fiat I h2/e read his apC{icatOl and seta �J:ct the =:cve inform atfon is com. fete and correct. 1 agree to
comply mithh ail requlremenu contz--ined herein and city ordinances a'd 3-2te lay.'s regulating'dlding rorstruction. I know that a
permit is not valid until it has been paid and issued. J
Applicant: ,
Print Name: nPj, _. r Sign tztura
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