HomeMy WebLinkAbout1313 W Myrtle St - Applications/Reroof - 06/13/201206/10/2012 22:56•FAX
la001/001
C rt Goblins
Planning, Deyelnt D Ttirartpor•ttation
lei N. College Ave P.O. Boa 580
Fora: Collins, CO a0524
Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This apply aHon In to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
0 Demolition (Interior non-structural) ❑ Electrical Afterabon (not service change) ❑ Gag Lighter 13 Oche Log
❑ Heating Unit ❑ Lawn Sprinider C] Mobile Home replacement 31,Roefing O Sewer Line ❑ Photo-voMe
17 Ventilation E3 Water Heater ❑ Water Una O Wood/Pellet Stove (mum! be EPA certified, provide make, model and
manufacturer).
Complete all app able lnformattion on the epplicadon. Incomplete applloatlons will not be accepted.
Appllc adon # 1� Dare LV
Far rya a* �—
Job Shin Address (ns+q *v0 Value of CrmaArucdon (labor, materials, profit)
13 /3 S v M- � 4 $ Soo-vo
Prope�nrjty Owner Name Address
City/State Zip
Phone
nl/r<ruu/ G rvtnlcOV / 3/ 3 WI m
,41- . S _ Ar 0/•hI ?t7'
of 70—`i49- 8' /
Applicant Name Address
City/Stage Zip
Phone
F r
Contreaor Lic # Address
C ity/State rip
F+ C I(frid
Phone
i E r
9
Co WwWr MV PL COIRns sales Tax #
Are you paying taxes here or try report?
VHere 0 Report
saw �n � A=*1edysum&araxx
Are you paying with your O%W account?
13 Yes L(No
is this a residential or commercial project? f"dential E3 Commercial
If residential, to It: Single Pwrilly betadted 0 Cando/townhome (single family attached) Cl Duplex
Multifamily (apartment) 0 Cgrage
If commercial, Is it 0 Bank 13 ear 0 Church 17 Hatel/Moiel E3 Medical ofnm Q Office 0 Ratall
0 Restaurant ❑ Other (explain)
Is this building So years off age or more? O Yea -)"o IFYas ynn may need m mnbet hysbew Pnsaarv®bm
If this Is for a denwIttlorr permit:, what year was the building ConstrUMM
1Fpnbr to 1973, you wr// need an amiashas anent lv sY&W wO Obi appAbrbba
of work
# AA L
*If lawn sprinkler/baddlow pmwnter, mustfist ficensed plumber. If thst-time A/C, must list licensed ekw&tdan.
Subomoscliww t& h4w awrgawrom or 0tv arR ChV1 s Amme 0
PWmtwr Mech RooW Other
1 hereby admowledge thhat I have road dris applkstlon and state that the above Information is eomP19W and correct I agree to
comply Will all rmOrernents contained herein and dtY ordinaries arid stage laws regulating building eonAruction. 1 km w that a
permit is not valid unW It has been paid and lowed. '
lla PAIR nronr►tavr.i s�nature�%I� t>bte