HomeMy WebLinkAbout220 Lyfka St - Applications/Reroof - 06/30/201602/05/2013 10:23 9705872178
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This appiicati(
❑ Demolition (i
❑ Heating Unit
❑ Ventilation I
manufacturer).
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Des.cription of v
Planning, Development & Transportation
281 N. College Ave P.O. l3ox 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
to be used to apply for the following permits only (check all that apply).13 Air Conditioning
or non-structural) ❑ Electrical Alteration (not service change) ' D Gas Lighter ❑ Gas Log
Lawn Sprinkler ❑ Mobile Home replacement/A(Roofing ❑ Sewer Line ❑ Photo -voltaic
ater Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
(cable Information on the application. Incomplete applications will not be accepted.
Date (4
oli9ce use only
(required) Value of Construction labor,; materials, profit)
1:�2A-Q61L1qz do
m� Address Gty/State Zip ::..phone
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Add City/State Zl 't{ Phone7()
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• r1 . 'r Address � CState Zip Phone �p
�CAhai. I g
t. Collo Sales Tax # Are y u paying taxes here or by'report? ❑ Here ❑ Report
dfed¢yalicvrtracmrs Are you paying with your trust account?Yes 17 No
Zmercial project? 7 e[Isidential Commercial
ngle,Family Detached . ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) E] Garage
❑ Bank ❑ gar ❑ Church .❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
13.
Restaurant L3 Other (eNebui
)
:arS of age or more? to yesVo If, yes, you may need to contact Nistnric Avsarvation
lition permit, what year was ilding constructed?
&Q11 need an asbestos assessment to submit wth this applicat/on.
c.
*If lawn sprinkler/kflow'preventer, must list licensed plumber. If first time A/C, must list licensed electrician.
Subcontractors: i f. the company name ar aty of Ft Co//ins I!CeMe ,
Electdda i� Plumber Mechanical Roofer9 Other
x hereby acknowled1111�
that I have read this application and state that the above information is complete and correct. I agree to
comply with all req menu contained herein and city ordinances and state laws regulating building construction. i know that a
permit Is not salt ntil It has been paid and issued.
Applleant: Fit
Print ft.:-45 h Signature paw