HomeMy WebLinkAbout455 N SHERWOOD ST - APPLICATIONS - 4/15/2019®City®t Planning, Development.. & Transportation Services
Fdrt Collins Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main: 970.416.2740 Fax: 970.224.6134
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 [RRoofing ❑ 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 # g4 9
For office use only
Date qq = /°!
gob Site Address (required) Value of Construction (labor, materials, profit)
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Property Owner Name Address City/State Zip Phone
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Applicant Name I Address City/State Zip Phone
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Contractor r Address City/State Zip Phone
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Contractor C'i�f R. Collins Sales Tax # Are you paying taxes here or by report? EC Here ❑ Report
Sales lax number is required by all contractors Are you paying with your trust account? 0Yes ❑ No
Is this a residential or commercial project? ® Residential ❑ Commercial
If residential, is it: ® 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 So years of age or more? ❑ Yes ®No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work 1, I oP RK, Poo !bo •1a Svskn1 ._.,G' 1a a L)".A
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*If lawn sprin r/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 P —/3S_7 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-,-- /� / �. ' ry 41 --
Print Name �„ nl�(� 0%�SL9/rT Signature--/'-=s Date
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Revision date 202017