HomeMy WebLinkAbout605 S SHERWOOD ST - APPLICATIONS - 12/26/20190651
City of
11 F� 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 ning
Demolition (interior non-structural) Electrical Alteration (not service change) Gas Lighter Gas Log
Heating Unit Lawn Sprinkler Mobile Home replacement Roofing Sewer Line Photo -
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 # Il )l I I I : 1 Date
For office use only
Job Site Address (required) I Value of Construction (labor, materials, profit)
�o06 S, '-,KcrW06J St- 'FCC. 6052- ( ,:� 3,956• /D
Prorrty Owner Name Address City/State Zi
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4pplicant Name Address
City/State Zip Phone
Contractor Address City/State Zip
aL F-(-•%o fxzs2t4
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report?
Sales tax number is required by all contractors. Are you paying with your trust account?
Is this a residential 7co idential Commercial
If residential, is it:ngle Family Detached n o/townho-Me (single family attached}
Phone
P/ 4%.9(:�9 Y
Here a ort
Yes No
Multifamll Duplex
y (apartm Garage
If commercial, is it: IF —B r Church Hotel/Motel Medical office Office Retail
Restaurant Other (explain)_
Is this building 50 years of age or more? Yes No Ifyes, you may need 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 w/th'this application.
Description of work
*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 #
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: S�f�
Print Name: C I�2( Sig
Date