HomeMy WebLinkAbout619 CHERRY ST - APPLICATIONS - 3/9/2016Ciof
Fort Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 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 #®� o� Date
.3��/ �6
For offlce use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
�k5 CMti' 4244 S'(
Property Owner Name Address
City/State Zip
Phone
G h C446V4M Lk C X?,
oj2, uwl) 6 F1 Ob 94-vy
q:J.,-W VeNo
Applicant Name Address
City/State Zip
Phone
Contractor Address
City/State Zip
Phone
Ewan 6�WVEP'7COR- vows 6041,--5 Co Su
51'8 5'y00
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? 19 Here ❑ Report
Sales tax number is required by all contractors
Are you paying with your trust account? ❑ Yes_
❑ No
Ll
Is this a residential or commercial project? VP Residential ❑ Commercial
If residential, is it: ,9 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? )M Yes ❑ No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed? l-i 2S (ASsv ro C-� 0
Ifprior to 1975, you will need an asbestos assessment to submit with this application.
Description of work 06M0L4710N oc nt_wbff-.
*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 license # MApT,, 5 �� o
/zPJK F'7. rout'-- S H i.t✓ LZ„c ¢r,o:�.. rT
Electrician kg e-L-eZ-7IZI CL Plumber Mechanical Roofer OtheP&AVAI ter%
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. _ A
Applicant:
Print Name:? e_& �61111"01 Signature
Date 1 b