HomeMy WebLinkAbout616 CHERRY ST - APPLICATIONS - 12/9/2016City of Planning, Development & Transportation
!°�
B . 281 N. College Ave P.O. Box 580
F6r� CoLli t s Fort Collins, CO 80524
Phone 970-416-2740 Fax 22+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 #I�UTIU)q Date
For office use only
Sob Site Address (required)
Value of Construction (labor, materials, profit)
L, u Ci�_Z'hA St .
(, 18 to
Property Owner Name Address
City/State
Zip tv�')l Phone o I::))
Cuc-. BuC V . � 1 to � ,, �� " -
(�
C Uhl co D-19 - Z 2-
Applicant Name Address
City/State
Zip Phone 110 -
CLr'1 a(lillPvL
Ln
�'1I�Ad/
�Jj?
Contractor Address
City/State
Zip Phone V'")
P W }v\,b i i, , .
4•66 "bZnve:>r ALk,
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here
or by report? CV Here n Report
Sales tax number is required by all contractors.
A-2) 7)
Are you paying with your trust account? Yes ( No
7 1
Is this a residential or commercial project? §M Residential ❑ Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached)
❑ Multifamily (apartment) ❑ Garage
If commercial, is it:. ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office
❑ Restaurant ❑ Other (explain)
❑ Duplex
❑ Retail
Is this building 50 years of age or more? ❑ 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 S
*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.
r ,1
Applicant: n
Print Name, )ay r Lny'--Y Signature Date