HomeMy WebLinkAbout113 N Sherwood St - Applications/Gas - Log, Line, Pipe - 10/26/2011OCT-26-2011(WED) 13:15
P. 001 /001
FCiof
ort Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970.416-274o Fax 224.6131
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (chock all that apply). Air Conditioning
Demolitlon (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, provfde.make, model and
manufacluror).
Complete all applicable information on the application. Incomplete applications will not be accepted.
16
Application # mate ) 0
For o//ice use only I `. t7
lob Site Address (requirrd)
113 N . s l-tt-Sa wao D
Property Owner Name
121t► r-A D`I 54 G2ET
Applicant Name
Contractor
Contractor City of Ft Collins Sales Tax #
S9/C 47Ynunter is nmuired by all =ntracrorx
Address
113 rJ s
Value of Construction (labor, materials, pront)
3jot> ,00
City/State ZIP Phone
P:�'exL-ur-JS Brs'21 ZILj_�3q5
Address City/State ZIP Phone
Address City/State ZIP
Moi3 iZ'�C�-S1DE F�—C.0 L.J_INs a,57,4
Are you paying taxes here or by report?
Are you paying with your trust account?
Phone
k9 S 9 (o-79
Here
Yes
Is this a residential or comm la ect? �I n Commercial
if residential, is It I Famil Deta ed Cando/townhome (single family attached) Duplex
Muidfamily (apartment) Garage
If commercial, is It: Bank Bar • Church . Hotel/Motel Medical office Office Retail
Restaurant OtheyLexplain)
Is this building 50 years of age or more? Yes No lfye� yvu may need ro Contact Hlsto* Frreeervation
If this Is for a demolition permit, what year was the building constructed7
if prior to t97S, you will need an asbestos sssessrnent to submit w/dr this application.
uescriptaon of work I N 5 774-L-1 D+ 2.Ec�'i' v c7r-"- I
5 S-rDv C- Pr .,+D N C
" If lawn sprinkler/backflow prevomer, must list licensed plumber. If Ar;t•dme A/C, must list licensed electrician.
Subcontractors: C/stthe compsnyname orC/tyo/FtCollin:licenser
Electrldnn ,- Plumber Mechanical
. Rcorcr _ Other_
i nereoy acknowledge that I have read this application and state that the above InFormatlon Is complete and correct. I agree to
mmpiy with all requirement; contained herein and city ordinances and state laws regulating building construction. I know that n
Permit is not valid until It has been paid and Issued.
Applicant:
Print Nome, Signature i0^Z(o--I
Dato