HomeMy WebLinkAbout908 SYCAMORE ST - APPLICATIONS - 9/8/2014Planning Development & Transportation
City
{of 281 N. College Ave f
F®1 ` Collins F rt Co lins, CO 80524
6�1r_ nZ0 416-2740
OVER-THE-COUNTER PERMITS
O. Box 580
Fax 224-6134 ` (�
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.
Application # I
For office use only
Incomplete applications will not be accepted.
Date
Job Site Address (required)
Value of ConstructiUon (labor, materials, profit)
G� s Sf
600
Property Owner Na e Address
City/State Zip
Phone
70� e`r
1 C' to Sb,-Z-7
qzlv r.?l
Applicant Name Address
City/State Zip
Phone
Contractor Address
City/State Zip
Phone
S'O A-
C Ii t D
Contractor City of Ft. Collins Sales Tax #
sales tax number is required by all contractors
Are you paying with your trust account?
,12-Yes ❑ No
Is this a residential or commercial project? EResidential ❑ Commercial
If residential, is it: 2 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? O'Yes ❑ No If yes, you mayneed to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work _L"A'0_t(
*If lawn sprinkler/back low preventer, must list licensed plumber. If Rrst-time A/C, mu? tAst licensed kliettrician. {�
Subcontractors: List the company name or City of Ft Collins license # g u�'�
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 law regulating building construction. I know that a
permit is not valid until it has been paid and issued.
Applicant: Print Name: \ ��( �, Signature Date l _ 27—(i
�1 �t�a