HomeMy WebLinkAbout616 CHERRY ST - APPLICATIONS - 5/8/2015Planning, Development & Transportation /
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524 .
Phone 970-416-2740 Fax 22+6134 -'
OVER-THE-COUNTER PERMITS ONLY Faxi
This application is to be used to apply for the following permits only (check all that apply). ❑ Air ConclitibAing TIf
❑ 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). O bA,
Complete all applicable information on the application. Incomplete applications will not
be accepted. ,
Application # F)y5o -21- 504 Date 5-3-1
5
For office use only
ob Site Address (required)
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Value of Construction (labor, ma rials, profit)
I I 'I n s C 5500. 00
P
operty Owner Name
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Address
City/State
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Zip Phone
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Applicant Name 0
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Address
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City/State
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Zip Phone q70
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Contractor
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Address
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City/State
5F. Unit z #190
Zip Phone
VJ indt6 . Co g10-aab-003
Contractor City of Ft. Collins Sales Tax
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Are you paying taxes here or by report? >CHere ❑ Report
sWestax number & required byall contractors.
Are you paying with your trust account? ❑ Yes XNo
Is this a residential or commercial project? Residential ❑ Commercial
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?
Ifprlor to 1975, you will need an asbestos assessment to submit wide this application.
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*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or aty of Ft Collins license # Rgg3
Electrician Plumber Mechanical Roofer 96912 ^)e— 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. Z�1\
Applicant:
Print Name: Yr Signature Date