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HomeMy WebLinkAbout520 N Sherwood St - Applications/Water Heater - 10/30/2018FliCity of Planning, Development, & Transportation Services rt Collins 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 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 Heat a Line ood/Pellet Stove (must be EPA certified, provide make, model and manufacturer). Complete all appl' ble information on he a o gopiplete applications will not be accepted. Application [ V, �j �t ID 3� �i V I e For office use only l Y Job Site A Tess (required) Value o Construction (labor, materials& o0) S� : N_ s�� ���.a 2� o� ©i i7- Property Owner Namel r Address City/State y/State Zip Phone 11E1Z � 1tl SLR 3Zc� 2 RY-L rf. c INN C(% '�O52 qV-2I416 Applicant Name / Address A� ,r / City/State Zip Phone G 6° 1 z (LI 6 AMY Contractor d Address City/State Zip Phone 1.-E ha cA' Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report Sales tax num Isrepulredbyall contractors ❑ Are you paying with your trust account? Yes ❑ No �:�J Is this a residential or commercial project? P Residential ❑ Commercial If residential, is it: ❑ Single Family Detached PLCondo/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 Ifyes, you mayneed to contact Historic Preservation If this is for a demolition permit, what year was the building constructed? Description of work e.. J aYL *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 //tense # 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: p, Print Name: 1 Jf-�l ��R o nature , paw to Revision date 2/612017