HomeMy WebLinkAbout3230 LYMEN ST - APPLICATIONS - 2/15/2018City of Planning, Development, & Transportation Services
,.Fort Collins Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main 970 416 2740 Fax 970 224 6134
-
OVERJHEiCOUNTER 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
f ( Application # l h6 l�1 Date z -- 16 1 0
For office use
Job Site Addre (required)
I ?
( Value of Construction (labor, materials, profit)
, e S �- gdsa �r7d ygl /S5
r pe Owner Name / A ress
City/State /7 /Zips Phone m
vl
Applicant Name Address
City/State Zip Phone
C/ontracWr 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
I
Is this a residential or commercial project? X-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 ❑ Hotei/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No If yes, you may need to contact Histonc Preservation
If this is for a demolition permit, what year wags the building constructed?
Description of work
1
I
I
ice
*If lawn sprinkler/backflow preventer, must list lice''
i sect 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 applicat4on
i
and state that the above information is complete and correct I agree to
comply with all requirements contained herein and 4ity
ordinances and state laws regulating budding construction I know that a
permit is not valid until it has been paid and issued.
Applicant: Qi
% (C�
Date
Print Nam Signature
Rev,sion date 2/6/2077