HomeMy WebLinkAbout3207 Lymen St - Applications/Reroof - 11/14/2011NOV/14/2011/MON 01:06 PM F AX No. P•003
-3^7512-7
City of
Flirt Collins
Planning, Development & Transportation
281 N. College Ave P_0. 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 )i Roofing O 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_ i Z
Application # . Date IL( — I I
For oyce use only
s;
Job Site Address (required)
Value of Construction (labor, materials, profit)
2trl L
2 .33 S t,ta�e
Property Owner Name
Address City/State Zip Phone
IUD s e
320 LA RAE-tJi CnLu K)5 gDLI
Applicant Name
Address City/State Zip Phone
Contractor
Address City/State Zip Phone
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? X Here ❑ Report
5a/esbzrumberisrequired byall convaaors
Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? ❑ Residential ❑ Commercial
If residential, is it: ❑ Single 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? ❑ Yes ❑ No Ifyes, you may need to contact Historic PreSerVation
If this is for a demolition permit, what year was the building constructed?
Ifpiior to 1975, you will need an asbestos assessment to submit with this application_
Description of work i:EhK o J Ir ! <C s-rt di-, F r)b-P 1 r, t -rr, Dge.L_ s rLgpLA[ hd
w1 e)I lA ' Coen c� lo„ nAZ t?h0i. p_
*If lawn sprinkler/backnow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors. L& the company name of City of Ft Collins license #
Electrician Plumber Mechanical Roofer Other
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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.
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Applicant:
Print Name: - � fg-P U LiIJ Signature Date
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