HomeMy WebLinkAbout3112 Lymen St - Applications/Reroof - 05/21/2013May 10 13 10:53a
1-970-669-5999 p.2
API e q se j'YT C(i L Pe r''1 — our -
City of"A
33 D /V, .1-r h e o Planning, Development & Transportation
o�cJ �.
281 N. College Ave P.O. Box SW
®� �Ol�if�5 e[Gy,YOS 3 7 Fort Collins, CO 80524
- Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not sere change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement .4 Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line 0 Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicableinformationon the application.
Application # a I
For office use only
Incomplete applications will not be accepted.
Date
Job Site Address (requlreo
Value of Construction (labor, materials, profit) '4ivl cl
.3 j la L Y ryi e—P l-1 J"(
((
'51 I., r1S 426,S a6 fi 7d-A,E7 Q —r
Property Owner Name
Address
City/State Zip Phone
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cK o� a � I-o� � i� ��Kste� L_� o►� c
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Applicant Name
Address
CiNState Zip Phone
%�•�-S it ,�oDi 1vr
30 N.
- /iO 0V t-1Gr17ciCo gOS3
Contractor
Address
City/State Zip Phone
A- -S. sh;rk /i0o-piv
970-&(oe; o ?9r
Contractor City of Ft. Collins Sales Tax
# y j 0 3
Are you paying taxes here or by report? ❑ Here Q(Report
Salmi bxnumberisregtdredbya!/mnbactors
Are you paying with your trust account? $Yes ❑ No
Is this a residential or commercial project? ,'Residentia) ❑ Commercial
If residential, is it: ;ft Single Family Detached 0 Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank CI Bar ❑ Church 0 Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this bull ding 50 years of age or more? ❑ Yes ❑ No if yes, you mmyneed to contact HlzOWPreservmbon
If this is for a demolition permit, what year was the building constructed?
ifprior to 1975, you coil/need an asbestos assessment to submit with this appl/ration.
Description of work io K
-Aov3c. -F^=14 -14 Sc,iA v F2 lc'ia�Y„was 5 F'Gcap
Vaitcv.g �.� clz,�ale5' _ l„��Ytmc-- Di.-+r•p{A s'�O�ti .� 1 o MPH , c1
*If lawn sprinider/baddlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Ustthe company name orCItyofRCoAnslicense#
Electrician Plumber Mechaniol Roofer Other
I hereby acknowledge that I have read this application and state that the above information is complete and correct 1 agree to
comply with all requirements contained herein and city ordinances and sta ws regulating building construction. I know that a
permit is not valid until it has been paid and issued.
Paint Name- '7-�'i d✓'� 1�1�/' Date
.� Signature
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