HomeMy WebLinkAbout621 SYCAMORE ST - APPLICATIONS - 10/26/2016City of
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 applica91);16
le information
�on the application. Incomplete applications will not be accepted.
Application # V "�� '" Date /0
For ofAce use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
Rryan J, l c4 pe 6221
Sue-d M Pre (01IMS:. t 0 IPS,00 t
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Property Owner Name Address
d
City/State Zip Phone
Applicant. Name Address
City/State Zip Phone
a
Contractor Address
City/State Zip Phone
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ,lf Here ❑ Report
5ales tax number is required by all contractors
Are you paying with your trust account? ❑ Yes M No
Is this a residential or � ommercial project? X Residential ❑ Commercial
If residential, is it: YM 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? XYes ❑ No Ifyes, you mayneed to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed? i4® S
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work A®uase d m® -4 ✓ ripux) home- A Jw, c-ADl
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company'nameorOtyofFtCollinslicense
#
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: q g / ' / J�
Print Named ut(f_ Ir u rl01b<l�W_Signature r J it k( 10-k 1.11.
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