HomeMy WebLinkAbout1513 Cherry St - Applications/Reroof - 10/01/2018Piaimning., Development, & Transporttation Services
Fort Collins
�.G Community Development & Neighborhood Services
281 North College Avenue
Fort Collins. CO 80524 Main: 970.416.2740 Fax: 970.224.6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits ofily (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 1>g' 0ofing ❑ 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 ontheapplication. Incomplete applications will not be accepted.
Application # e�U)00SS V Date
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
IS 3 V t I,i M GO -qwn
Property Owner Name Address City/State Zip Phone
youRaWs 15 (MA S , °IDl - a3) - 91� 0
Applicant Name Address City/State Zip Phone
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mcd 14EM, �:c5rr;�o z
Contractor Address City/State Zip Phone
2� —7
Contractor City of Ft. Collins es Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
Sales lax number isrequired byall mnaacmrs. Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or co5percial project? ERIiesiclential ❑ Commercial
If residential, is it: M Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex l
❑ Multifamily (apartment) ❑ Garage
y
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ElOffice ❑ Retail Slim
❑ Restaurant ❑ Other (explai
Is this building 50 years of age or more? ❑ Yes o If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work +yx
a
*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 #
Electrician Plumber Mechanical Roofer Ydu!n'r�p
VA 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: l,L Signature Date [oil jig
Revision date MQ017 V ��