HomeMy WebLinkAbout620 JANSEN DR - APPLICATIONS - 9/26/2011Sep . 26. 2011 1 :11 PM ADVANCED ROOFING Planning, Development & Tras,,�; 634n P . 1 /1
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City .of 281 N. College ,4ve P.O. Box 580
�t Collins . For Collins, CO 80524
P"one 970-416-2740 Fax 224-5134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following pe", its only (check all that apply). Air Con�;;icrr,c
ED Demolition (intarcr ncr:-st-.:cturai) r_t _iectrical .Alteration (not sa'vica C`ancs) _1 Gas Lighter C Gras Log
❑ i'ieatlna Unit L'_ Lawn Sprinkler � MobiI=- �on'e re.^.Iccerie71 .' Rocrinc U Sewer Line L' Phcte-vClta[C
C. Vamilation C Wooer Heater ❑ Water L :ne 'I`.rocdlFsfiat Stove (mustoe P,ovide makcl model and
rnanufacfurer).
Complete all applicable :nformvion on t E apclicatic;,, Incvnpiete application will not be accepted.
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)cor oi7c= use only
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Prope.^y 0wi i@r Name
ip
phone /
Appiicar,C Nzr e
4ocress
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Phone 70
(}DVf�Nc� Zoo n� leehn� �s �c�
3,r4-s 02 wt►uis')r
Co R6Ssp
(063-68)0
Con acor L ?c
Actress
Ci l; Stdt2
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Phone
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Ccn� occr Cty of Ft. Collins Sales Tax
Ar 2 you paying nxs jar=_
or by Heron_% _
ii,ere D Rcccrt
Sal2s?xnumteris, re-quiredbya/lcor, ccrs.
A'_ you p2yir!g with your U=; aCccun� yes ❑ Flo
a gos[D
Is tis a r`siden:ial or �cz)mmercial project? ('�.Rcslcen zi ❑ Connerciai
Tf res:dent:2l� IS $: NinglEFamily Delved ❑ Ce^GG/town crne (Slrigie i ''fly a- shed) ❑ DuPlex
❑ Mul�Vlamiiy (aea; Lie , j ❑ Garsee
Ii CD�T�n2•'Cial, ?$ It: ❑ �2(;k ❑car ❑ C urch ❑ �Jct_l/!�lct_l ❑ Me ' ( oi,1Ca ❑ office ❑ REtail
❑ Ras`taurant ❑ lei (-,-'Dien)
is this building 50 yeam of age cr rncre? 0 Yes ';9qVe i; Y=` ycu cz nrtcYisoric P:asefwvi on
?` iris is `or a demolition permit, whet, y=_ar wzs the uil ing c-nstructet
L`prGr i7 l975, you will ,�EE� 2n 2s<`7est 5 d5:e.E:me-' .10 sucm/ W%U7 r7i5 2�F/iai;Cn.
of work
*If I2WG SP riikEr/ 2CC1CW riEVEn[3!, mcs IISt IICE%SE? CIL fE.', if rirs'-tr-ne ""C, ^lust ki t licensed, E.e c�;IG2n.
5uI=nt. ac crs; Lis ae ccrAany,-nifine cr CLI C( Fc
yEcaric°i Rcofer i, ( l �1 aver
e!e^Car. DIurGEr
' I h2r2badc,1ow!e?Ge � z-t I halie rE2d: i4- 2_}iica"`cn and stx= t'2� ; 2C a �: S C e 2 CQr-=r. 1 2Cre_ :] y _ t e ov_ inr�r: E::cn i_ =rills;_ rid , _
C.m I wit; all reQuire nenu CCr ln�r ne!e:n ?i:C Cit ^rC lnanCc$ a C Stc laws re- o ^ n r_. i a
pY / �, ;_.«:r� �cil:i, ccr._�,�ccn. I krcwtiat
per -mil is not valid uriil it has been paid and iss ,ed
Applicant. �] �. G� C� r 'ee1
Print Name: Sign?_:__
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