HomeMy WebLinkAbout310 N Sherwood St - Applications/Reroof - 08/28/2018CityOf Planning, Development & Transportation
F ♦ I I , 281 N. College Ave P.O. Box 580
l Collins s Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
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 ❑ 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.
Application # o-10Z.,
For office use on y
Date b - a � ) 0
Job Site Address (required) .
Value of Construction (labor, materials, profit 9' W
310 5 H E K\,JQ0i
5-r, rorTL.0L-L.:c�S 10a1
9-70)aIS-133
Property Owner Name
Address
City/State Zip
Phone
_FQj4A S L A
L_T- Al 1
fE-1k✓0O D S T ' V s a
910 - a I J- g33
Applicant Name
Address
City/State Zip
Phone
K I v-rf t
G 0 1 ( 5,J NN
(P C S -r b P- "fsNIAIAT-Vf e 0
9 70 39 -a b,2
Contractor
Address
City/State Zip
Phone
Lon F Iv -f
-r_
TS
303-910-0 S
Contractor City of Ft. Collins Sales Tax #
Xre you paying taxes here or by report?
KHere ❑ Report
Sales tax number is required by all contractors
Are you paying with your trust account?
,❑ Yes ❑ No
Is this a residential or commercial project? 21 9esidential ❑ Commercial
If residential,' is it: Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/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 Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If prJor to 1975, you will need an asbestos assessment to submit with this application.
of work
TC) T4 E
*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 # 2
Electrician Plumber Mechanical Roofer � `taOF.��ther
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. I know that a
permit is not valid until it has been paid and issued.
Applicant:
Print Name: K F ? // G Z JSignature Date