HomeMy WebLinkAbout412 LILAC LN - APPLICATIONS - 4/24/2019Fo t Collins
Planning, DevelopnrentfbTranspmtation
281 N. College Ave P.O. Box 580
Fort Co18RS, CO 80524
Phone 970-416-2740 Fax 22+6134
OVER-THE-COUNTER PERWS ONLY
This application is to ba used to apply for the following permits only (check all that apply). 0 Air Conditioning
0 Demolition (Interior non-structural) 17 Electrical Alteration (not service change) O Gas Lighter 0 Gas Log
0 Heating Unit 0 Lawn SprMler 0 Mobile Home replacement lRooft d Sewer Line 0 Photoaroitalo
O Ventilation 0 Water Heater 0 Water Line 0 WoodlPellet Stovis (must be EPA cerfiffed, provide make, model and
manufacturoer).
Complete all applicable Infocnm ion on the application. Incomplete applications will not be accepted.
Application # won . ,, �2z( W
Forefikeuseo* /— STo/z>/
Sob Site Address (requW
Value of Construction (bWr,, matemft profit)
Property Owner Name Address
City/Rate Zip
Phone . eL
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Applicant Name Address
(Sty/Sty ZIP
Phone
BD t eT S-Sx 6A Wo � �� �, 'a.
f 1r _t0(• Co. SOMm
R10-653 -60cl
Contractor Address _
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(_ 1Cily/State ZIP
ail J a1
Phone
Contractor City of FL Collins Sales Tax #
satesaornren6or[s d6ysUcn act Are you paying with your trust acmunYl.
--
as I No
Is this a mddmUd or commerdai,.pmjed? g Reddential 0 Commercial
If raaldettial, is it: 0 Single FtinIfy Detached 0 Condo/tawnhome (single famlly a" 0 Duplex
O Multifamlly (apartment) 17 Garage
If commerdat, is It: 0 Bank 17 Bar O Church 0 Hotel/Motal 0 Medical office [7 Office 0 Retail
0 Restaurant 0 Other (explain)
Is this building 60 yam of age or move? 1 Yes Cl No If yes. you may need to'aon&a[ NaWilc mwamWw
Ythis Is for a demolition permit, what year was the building construed?
£Pp-br f o .IW4 you wNneed an asbestos awassamot to submit wddr d&appffaWon:
Of
lawn sift der/baddlow preverrter, must IU Itcensed plumber. If fir&4nv A/C, must it fk:ensW ehxtrwan.
SubconbudormU4the aompanyAwn orOfyofFtColftIkerrse�
Bedriden f nber Mechah ~ ttaofer_Z.13 3Y other
—
I herft admowledge that I have read this application and state that the above information Is complete and correct I agree to
comply w1h all requirements cordalnel herein and city ordinanow and•ste laws regulating buodmg congruction. I know theta
permit Is rMvalid until It has been paid and issued. _
Applicantr
Printflamm•,3 C+A signature
Date
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