HomeMy WebLinkAbout520 N Sherwood St - Applications/Reroof - 01/27/2016 (2)`rt Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 22+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 13 Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Completeall applicable information on the application. Incomplete applications will not be accepted.
Application # J30 (go G Ld Z I Date
— J
For office use only V V
lob Site Address (required)
6c +
Value of Construction (labor, materials, profit)
Cdl I,
%OS
-
Property 0. erName Address
C�lCc ) a
City/State Zp
one
7� Z
h
Applicant Flame Address
City/State Zip
Phone
Contractor. ` Address
City/State Zip
Phone
Contractor City of Ft. Collins Tax #
Are you paying taxes here or by report re 0 Report
-Wostax numberkrequiredbyailcontractors
Are you paying with your trust account' ❑
Yes `
Is this a residential or commercial project? i&Residential ". ❑ Commercial
If residential, is it: ❑ Single Family Detached ncfo/townhome (single family attached) ❑Duplex
❑ Multifamily (apartment) arage
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 HistoricPfesenadon
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you wi!/need an asbestos assmument to submit with this application.
Description: of work
1Gr ' A LV
*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 Fi Collins license #
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. I know that a
permit is not valid until it -has been paid and issued.
Applicant:
Print Name: Signature
Date
L/