HomeMy WebLinkAbout725 S Lemay Ave - Applications/Demolition - 08/11/2014Planning, Development & Transportation
City
Fy} of 281 N. College Ave P.O. Box 580
ort Cdhht Fort Collins, CO 80524
y�. `r�M�"-""'�► Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
TI)is application Is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
emolition (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 4t
For office use only
Date CIO Y
Job Site Address (required)
Value of Construction (labor, materials, profit)
7%15- s 4. h a.
4Z2ra O
Property Owner Name
Address
City/State Zip
Phone
In %1"-,.r'
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706 S C..L(
P.At C,ll
Applicant Name
Address
City/State Zip
Phone g0
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4 C P IlXs 6d ZI T70
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Contractor
Address
City/State . Zip
Phone
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? ❑ Residential Acommercial
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 ARetail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes 014o If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed? �96—
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work Dti- F'�_l I-e- "— .%��Fi t`-.w
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List rt,he col—mpany name or City of t Co/pins li�pTnse # '4 J /
V bfIU"t it {i��( i3'Vrt�s l.s ��iLMhI- I �O Y'7�y�1 -
Electrician�_ Plumber010a 6_ 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: / L
Print Name: A c) oe /" a� Signature Date
;2
—73
33