HomeMy WebLinkAbout4615 HOGAN DR - APPLICATIONS - 5/9/2014Planning, Development & Transportation
City Of 281 N. College Ave P.O. Box 580
F6I t Collins Fort Collins, CO 80524
/r"�� Phone 970-416-2740 Fax 224-6134
ca I.711.3C)
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 # 14022A7 Date
For office use only
Job Site Address (r uired)
Value of Construction (labor, materials, profit)
' / Jr' . A/
4�
`/� 00
PAC 40— 442 3/ e�e9.
Property Owner Name
Address ' City/State Zip'
Phone
Applicant Name
Address ;City/State Zip
Phone
8 ,e.,, 3
Contractor f
,�li /JG /
Address City/State Zip
3 $w.ew a • W4
Phone
-79 s3
Contractor City of Ft. Collins Sales Tax # .
sales tax number is requited by allmntractois., Are you paying with your trust account?
❑ Yes 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 0Hotel/Motel ❑ Medical office Office El Retail.
❑ Restaurant JLOther (expla'n) J9lL0 ' 2TI�i
Is this building 50 years of age or more? ❑ Yes ,!-Dlo If yes, you may need to contact Historic Preseruadon
If this is for a demolition permit, what year was the building constructed?
Yprior 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:���,., v� ,.
Print NarnJ_0W c Signature Zweg.