HomeMy WebLinkAbout418 Lyons St - Applications/Demolition - 05/29/2013Fort Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
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 service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # ?� 13 0 0?S 45 Date S �a Cl
For ofce use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
%S000 °'e-
q 14F l oN s
Property Owner Name
Address City/State Zip
Phone
�33 ka c Fo Co(U*s
wuo
Applicant Name
Address City/State Zip
Phone
Contractor
Address City/State Zip
Phone
1 1
7JO
µM C�
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here
❑ Report
Sales tax number is required by all contractors.
Are you paying with your trust account? ❑ Yes
❑ No
Is this a residential or commercial project? KResidential ❑ Commercial
If residential, is it: XSingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? Kyes ❑ No If yes, you may need to contact Historic Preservation 1
If this is for a demolition permit, what year was the building constructed? A 14 e � Wholey�ou Se.
If poor to 1975, you will need an asbestos assessment to submit with this application.
of
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*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license #
Electrician Plumber Mechanical Roofer Other
I hereby acknowledge that I have read this application and state that the above information is complete and correct. I agree to
comply with all requirements contained herein and city ordinances and state laws regulating building construction. I know that a
Permit is not valid until it has been paid and issued.
Applicant: 1 ( ' �•iq'a �(3
Print Name: c) li N �1 rZ . A Signature � �J Date