HomeMy WebLinkAbout5313 Mail Creek Ln - Applications/Reroof - 08/07/201408/07/2014 11:51 9704612547 ATLAS PAGE 01/01
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Collins, aD 50524
Phone 970-416-274o Fax
OVER=THE-COUHTER PERMfT$ CM
Ion is to be used to apply for the t1011ow&tg psrmgs onW (check an that api
pr"dOr � D 6ecbical Alteration (not se a�change) D Gas LJj
fi D Lawn Spdnlder D Mobaia Horne replomment ❑ Sewer Tina
d water HeOW ❑ Water L W* D WOodlpellet Sto% (must be EpA certified,
appllcoble information on the application. incomplete applications wt11 na
# Q,1'��55� 2 D t
For &Ift&MQ
rem i/a4u Value of constru:Uon pat
S121.
17 AirCorling
D On Log
PhoWvoRaic
Ida make, model and
accepted,
Name Addren Oty/stoth3 Zip Phone
Address City/Stale Zip Phone
II Ir
Address city/staw Mn
of Ft Collins Tax # +y 107516 Ana you paying axes here or by Here D Report
Are You paying with your trust Yes D No
Mal or comnherhtial p *ce qRsslderm D Corrunendal
e it: D Single FM* Detathed, D CondO/townhcrne (single fanOy atadhed)
D Mukifamny (aparbtwo . 13 Garage
is it: D Bank Dear D Church D• MON/Motel 0 Medical owe D pffioe D
D kestsurarrt D other (fin)
SO years of age or more? ElYes D No, If) )Oj maYfAftd fv 4QMW ff6M
lemon permit, what year was the bulkong oonh;<rhrfed7
Vpwnffixedana 8MffMxWioSU&7*VAH lids
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lawn /Wddtow FWarter, Inuit list ibensed pfu moor. Ir first-tl M q/C, must W RM' Sad
Lbt dle Y/+amh� arLifiyaefR6aarrse �#
f4urmer Room
I haeby adt that I have reed tthi6 appOo dw and state that the abo4 edbrmetorh b apmpfete
CMI* V I contathed herein and dty a Amwx. s and state fawn Mwjke ft badlding aor
penn0 le let =0 it has.been paid and issued, .
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