HomeMy WebLinkAbout420 HUDSON CT - APPLICATIONS - 8/26/201108/26/2011 13:47 3032923387 PREMIER PAGE 08/09
city of
Fort Collins
ER -THE.COUNTER PERMITS ONLY
OV
all that apply). ❑ Air Conditioning
This application is to be used to apply for the following permits only (check
❑ Demolition (interior non-structural) O Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement XRoofing O Sewer Line provide❑ Photo-voltaicand
❑ Ventilation O Water Heater O Water Line O Wood/Pellet Stove (must be EPA certified,
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
Application #
For office use only
Job Site Address (required)
4qn t+1Ads-Dv1 CDV'�
Property Owner Name Address
rim Foalesro-I-I 490 tWsrm Ct
Applicant
Address
25'1D W. V*
Date 9 0 11
Value of construction .(labor, materials, profit)
City/state
Fn+CvItias VI
City/State
L 'pQ,>nYEY, CD
Zip Phone
5 970.�Jlu. Y3?O
Zip
,lt4 .... Zip
Address City/State
Contractor
Prexn��l' �00p Co - 25'TD w-8A"At�0 Oenv2r CO 80204 31
Are you paying taxes here or by report?
Contractor City Ft. Collins Sales Tax Are you paying with your trust account?
sa/es tax cumber is required
equired by all cono-acrors
50940
Phone
03 . q�t9.3'1 D2
Phone
l3 . AS-5. r71A05
1gf Here O Report
❑ Yes 19 No
Is this a residential or commercial project? ;9 Residential ❑ Commercial ❑ Du lex
If residential, is it: Single Family Detached O Condo/townhome (single family attached) P
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: El Bank ❑ Bar Q Church ❑ Hotel/Motel ❑Medical office Q Office ❑Retail
Q Restaurant ❑ Other (explain)
Is this building so years of age or more? O Yes K No If yes, you may need to contacr Hismric 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.
d.
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time AX, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins licenSe
Electrician Plumber,
Mechanical Roofer Z1 B 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: Date
Print Name: �s� Cod H n Signatur —