HomeMy WebLinkAbout520 N Sherwood St - Applications/Mechanical - 10/30/2018FCity of A' Planning, Development, & Transportation Services
lirt Collins Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main: 970A16.2740 Fax: 970.224.6134
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 EPA certified, provide make, model and
manufacturer).
Complete all applicable informationn the a Go plete applic Ions will not be accepted.
Application # e I 3�
For of ice use only
Job Site Address (required) ue Construction (labor, materials
Property Owner Name Address City/State /1 �Z/ip Phone
llEf� �L 11� 0 �%c� z V3� I yL �. N l�� b052 gi10-214 14
Applicant N e Address City/State
Zip Phone
u "�- 2, z Al
Contractor Address City/State Zip Phone
Contractor City of R. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
Sales tax numbqr Isrequlredbya#conbacto7s Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? P Residential ❑ Commercial
If residential, Is it: ❑ Single Family Detached O—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 SO years of age or more? ❑ Yes ❑ No Ifyes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work c , �, �LrL
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: L/st the company name or City of Ft 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: I ffi.0
nature Date /o
Revl¢lon dale 2/6/2017