HomeMy WebLinkAbout612 SYCAMORE ST - APPLICATIONS - 8/14/2018Aug 03 18 11:08a Severe Weather Roofing 9702233383 p.11
FOtyal Pla..,ring, Development, $ Transpwrtation Services
lirt Collins Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main: 970.416.2740 Fax 970.224.6134
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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.
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Application # Date
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
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Property Owner Name Address City/State Zlp Phone
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Applicant Name Address City/State Zip Phone
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Contractor Address City/State Zip Phone
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Contractor City of Ft Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
salesrnumberisrequkedhAre you paying with your trust account? ❑ Yes No
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Is this a residential or commercial project? ❑ Residential ❑ Commercial
If residential, is it: Single Family Detached ❑ Cando/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 O No If yes, you may need to contact XistwfcAeservabon
If this is for a demolition permit, what year was the building constructed?
Description of work ain ve, �i 0 .cw7 or „ I V7ri , , ; •. !4 C
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*If lawn sprinkler/baclflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the mmpanynameorCity ofFtCollins license # r�
6ectrician Plumber Mechanical Roofer TOE F06Pq 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:
Print Name:_ JG5V��_ Signature Date 2 r4
Revision date 4,r of 7 i v