HomeMy WebLinkAbout520 N Sherwood St - Applications/Reroof - 04/22/2019 (8)City of Planning, Development, & Transportation Services
Fort 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 Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # f2 f q 0 02 (40
For office use only
Date 4l 1
Job Site Address (required) Value
I Value of Construction (labor, materials, profit;)
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Property Owner Name Address City/Stqte Zip Phone
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Applicant Name Address City/State Zip Phone .303
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Contractor Address City/State Zip Phone �6
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Contractor City of Ft. Collins Sales Tax # Are you paying taxes hetie or by report? ere ❑ Rgport
Sales tax number is required byall contractors. Are you paying with your trust account? ❑ Yes �No
Is this a residential or commercial project? ❑ Residential ommercial
If residential, is it: ❑ Single Family Detached ❑ 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 50 years of age or more? ❑ Yes ❑ No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Des ription of ork ' _ S S I2 ; 12
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*If lawn sprinkler/bac ow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the companyname or CityofFt Collins license #
Electrician Plumber Mechanical Roofer Other
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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: h /)
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Print Name: ' / /, jjj Signature Date
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