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HomeMy WebLinkAbout6215 CLYMER CIR - APPLICATIONS - 1/25/2019Pl�nn%ng, ®eV�I®pm��a, b Transportation Services Fortµ3C®llin5 Community Development & Neighborhood Services 281 North College Avenue Fort Collins, CO 80524 Main: 970.416.2740 Fax: 970.224.6134 \�O�A 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 0Water 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 #__ > 1of© 0521 Date 125NZ01 For office use only Job Site Address (required) 62i 5 C qW C Y.CV-, Value of Construction (labor, materials, profit) ice, SC 5 4� urStMr Z15 6uw Cifc� N160-225-01 Property Owner Name Address City/State Zip Phone QAil 66 Lns U M'34 970-715 2- Applicant ame i Address City/State Zip Phone 49gi5arA ail c plc CA " 0 970- VI 707- Contracto J Address City/State Zip Phone Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report Sales Jay numberisrequiredby,?#contractors. Are you paying with your trust account? ❑ Yes ❑ No Is this a residential oi�co/mmercial project? esidential ❑ Commercial If residential, is it: single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex ❑ Multifamily (apartment) ❑ Garage It commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office t3 Office ❑ Retail ❑ Restaurant ❑ Other (exp)a►n) Is this building 60 yearn of age or more? ❑ Yes No /fyes, you may need to contact Historic Preservation If this is for a demolition permit, what year was th building constructed? Description of work cS LQ *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 �f 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. 1 know that a permit is not valid until it has been paid and issued. Applicant: Print Name_ ml, C0+ft Signature Date Z 5 ZOO v v Revision date 202017 V I