HomeMy WebLinkAbout4142 MOSS CREEK DR - APPLICATIONS - 4/5/2012Apr. 5. 2012 11:30AM ADVANCED ROOFING No•4093 P. 1/1
Planning, Development & Transportation
City Of 281 N. College .Ave P,0, $cx 580
Flirt Collins Fort Coilins, CO 8052"
Phone 970-416-2740 Fax 224.5134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). a Air Conditioning
❑ Demolition (interior non Jcturaq ❑ Wlectrica! Alteration (not service chance) ! Gas Llghier ❑ ,r.-as Log
Heating Unit ❑ Lawn Sprinkler ❑ Motile ,Home repiacsmeri '-j' Rocrng 0 Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water ^eater ❑ Water Line ❑ Wood/Pellet Move (must be EPA carified, pr_vide make, model and
rnanuiacturer),
Complete all ap b!= inform Lion cn the application" incomplete applications will not be accepted.
Applicacon = 184(o Date `"T�" tZ.
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Property Owner Name AddressCi~�/Szie
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Appk3nt Name Address
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City/Sig:_ . �p
Phone
Cont a�e,cr City of R_ Collins Sail Tax
Are you paying wxas her=_ or by report?
❑ Here Q Report
NeS lox 1740b4rSrquireeby cal CJn�`2c'
Are you paying with your t, acmurt?
hkyes El No
ago5cp
Is tNs a residential or cor„mercal project? 1 Residentai El Commerdal
" If ra,C_ itaf, im k.. '$ Single- Famuy Detached ❑ Cgnd'o/tcwn`eme (slnyie f?laily a' =cued) ❑ Duptex
❑ Multfamiiy. (aparlent) 0 canoe
If come e7cial, is it: ❑ Bank d Ear ❑ Church U Hotel/Motel El Medical fffze 0 Of -Ice i Retail
❑ Resmurant ❑ other (exciain)
Is u5is building 50 years of age or more? M ye= �kNe I`yes, ycu may Teed"to cnr,-mrs?Istnric Preserradon
If this is for a demolition permit, what year was tr,e building constructed?
if pncr to 1975, you wll/ need an asbestos assessment to submit wirn Iris appilcaecn.
of
*Ii lavm spri , 1ef/bzdq1ow preve:,ter, must list licensed piumber. If First-tme A/C, mug, list, jicansed cle_�riclan.
subcon."rac`crs: t.%st aye ccnny name cr city off: co/llns T _
EieC,idz^ ?lumber lic?i Rcofe- Cther
I hereby aC.ncwle�gd that I h_ve read this appiice6C i and state t,;_i the _cove infar,,,Guon is =mple_e and correct. i agree to
conpfy wlLl. all requirenenu con[.Inad herein and City or finances and. $nte laws rc&ul_ti?C buRd ng CDns', u&jon. I know tha` a
permit is not valid until it has been paid and issues.
Applicant: t
print Name' C-� Signature Il f Date ` 2,
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