HomeMy WebLinkAbout1809 WILLOW SPRINGS WAY - APPLICATIONS - 8/3/2012Aug. 3. 2012 10:12AM ADVANCED ROOFING
City of,
Pit Collins
Planning, Development & TraN obp4ul 8 8 3oanP
281 N. Ccilege .AVe P.O. BOX 580
Fort Coilins, CO 80524
Phone 970-416-2740 =ax 22G51�4
OVER-THE-COUNTER PERMITS ONLY
This application is to be used tc apply for the following permits only (check all that apply). Air Conditioning
r_ Demolition (Interior non-stru&Wrcl) El c!ecti°ICaf AltBratiCln (not service change) Z-3-as lighter ❑ Gas Log
I i Heati;,g Unit ❑ Lawn 2-cr;nkler ❑ Mobile Home aoscanent M.,[Rociii ig J Sewer : ine 0 Photo -voltaic
❑ Ventilation n Water I"leater ❑ Water Line ❑ Wood/Psilet SioVe (mL'st be -oA Car ;iie�, Provide mn—ska; modest and
manufacturer).
Complete all applicable iniormation on the application,
Appkation #r 8>1 2-O LI-772,
For ofi9ce use only
Incomplete applicatio s will not be accepted.
1 j"Gh Site .A d rPtt o, ri n�i
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vaiUe C::onGtrwction labor, (natarie!s, prcrlt)
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Property Owner Name
Addr?G
City/S to u`p
phone
Applic ant Name
Address
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Contrraccr UC m
Adl,-ess
City/S2t=_ yip
Phones
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Contractor City ofFt Collins Sales Tax
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Are you paying nixes mere or by ,Iercrr?
❑ Here ❑ Repo
5e%5i�Fxnumbe• rfegL&eDbyallccrmacrjr.
A;? yCu paying widl your tu-u t account?
as ❑ N0
Is rzsidenLal or comnerc;al project? `L�`�,Rasid=nbal ❑ Cer; nerc;al
I` re=_idenuzl; L it: '$ Single Famfiy' Detsched" ' ❑ Condo/townhcre (sindfe Emily a *�chedj ❑ DLPIEX
❑ Mulffaniiy (apa't ens) C] Garage
If czrnrerual, Is It: ❑ Sank ❑ Be, ❑ Church ❑ HCte!/Motel ❑ MedlCal cf llC_= ❑Ratsil
❑ Rest--u -ant ❑ Ctt18r (axpialn) .
is this bu6ding 50 years of age or more? ❑ Yes Lh�Ne if yes, you r„ay need`o cnr,in3c' ,-uric PrEs2rra 'er,
if this s for a dencfition permit, what year was :� a building Conte aced?
Ir,0r0r to 19,75, yCu Vd11 need an asbestos essessn, e: ;c io sub ,nit 1411c5 lrrls aFc�licarcn.
of
*If fzwri srr,i,Kier/Lac'GICw pr2VanL=r, nU , IIsL lice—nSed-ILmOer. if fi=i-t"ME• 1/C, r-%St I!S ilC9^ cC E:er;iGan.
Suocol,trac`_ors: Ust Die ccr er y acme Cr City ci F3 CC//ins irc=rse .=
c;er'iCa.^. •!ur,"- Me_3ni<2(! R=fa' )Iwr � Ocher .
I hereby edlnoviiadda that 1 have read this ap!_'Iicnldr,I and swte i a'n Correct. "—
L ill ac:,V inrc;-�c.i..�1 S ..rpi� and Cdri2 . agree to
Comply NA n,$lI (EyUlfv enU CCnigi^ad n@rein ZP.d Gij C(dirZnCaS a';d st - Ic'w5 ieCLlaiiilg UIICInC G7n5u'U^On• I know that d
permit is rot valid until it hzs been paid and 'sssLrd. -
1
Applicant: /
Print Name: Y1QP.,-C _ 4Je _� 9 c7ta—
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