HomeMy WebLinkAbout520 N Sherwood St - Applications/Reroof - 02/05/2016city of
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Collins
Planning, Development&Transpottation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 .Fax 224-6134
OVER-TEE-MUNTER PERM S. 014LY
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
Heatin ' Unit ❑ Lawn Sprinkler 0 Mobile Home replacement 0 Roofing 0 Sewer Line ❑ Photo -voltaic
❑ Ventilation 0 Water Heater ❑ Water Line 0 Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complei6oll applicable information on the application. Incomplete applications will not accepted.
A (icatio_ n# I d, f i (0 Date
pp For office use only
3ob Sitte Address (required).
Value of Construction (labor, materials, profit) Q
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Property Owner Name Address
- City/State Zip9ne
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Applicant Flame Address
City/State Zip
Phone
Contractor;. Address
City/State Zip
Phone
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+41 5J I &J\CJ I&X
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ContractorlCity of Ft. Collins Tax #
Are you paying tuxes here or by report?
❑ Report
Sa(gstwnumber&ie wmdbyall conbacwm
Are you paying with your trust ao=nt? ❑ Yes
Is this a residential or commercial project? Residential `13 Commercial
If residential, is it: ❑ S"R9le Family Detadded ❑.Condo/townhome (single family attached) ❑ Duplex
uitifamily (apartment) ❑ Garage
If commercial, is it: Bank ❑ Bar E3 Church ❑ hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50. years of age or more? ❑ Yes 17 No If yes, you may need to contact Historic Preservation
If this is fora demolition permit, what year was the building constructed?
If prior to 1975, you W//need an asbestos assswment to submit ryiifi fts app/Ication.
of work
S
*If lawn sprinkler/baddlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors:. List the company name or City of Pt Collins license #
Plumber Mechanical Roofer Ot&
I hereby acldwWedge 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 knave that a
petm## is not vaNd until it has been paid and issued.
Pflnt`Kanwn - 441e7�t-c) Signature /��