HomeMy WebLinkAbout6008 HUNTINGTON HILLS DR - APPLICATIONS - 10/10/2011Cit Of Planning, Development & Transportation
�F�c 111���y} 1�1 281 N. College Ave P.O. Box 580
o ` Colti IS 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 Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement XRoofing ❑ 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 #
For office use only
Date io' 11ol i l
T
Job Site Address (required)
Value of Construction (labor, materials, profit)
�C)C"'O kCtMTIN6 WLLS 02 (--1. COLLINS ea�S
Property Owner Name Address
City/State Zip
Phone
TE U I t'i" (cCr_G WWJl l Nb
(`TILLS 012 FT C O(_U NJ S
Applicant Name Address
City/State Zip
Phone
Contractor Address
City/State Zip
Phone
WMARC b-r 5- C G &D W CE D2%3 Lkwd et02R
--3� 98/ 1.1
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
i�'Here ❑ Report
Sales tax number is required by all contractors.
Are you paying with your trust account?
❑ Yes )�LNo
Is this a residential or commercial project? SEH esidential ❑ 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 INo If yes, 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 with 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: �p
Print Name: 1 'g �,��� ' C. Signature Date