HomeMy WebLinkAbout836 HINSDALE DR - APPLICATIONS - 9/9/2014Planning, Development & Transportation
City of 281 N. College Ave P.O. Box 580
�F6rt Coltins 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 ❑ 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 # ILDpl
—1-7155- Date -1 -I-ll t`ter
For office use only
Sob Site Address (required)
Value of Construction (labor, materials, profit)
Property Owner Name Address
City/State Zip Phone
CP) 'x). 9.
Applicant Name Address
City/State Zip Phone
i
Contractor Address
Zip Phone
City/State��
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? t2 Here eport
Sales tax number Is req1edbX Il c n( cmrs.
Are you paying with your trust account? ElYes ed No
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 So years of age or more? ❑ Yes PbNo If yes, you mayneed 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.
Descri tion of work °+- C U
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r vi gp Lz 1 Ce�, .100 VL-0 b
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*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Llst the company name or City of Ft Collins license # G
Electrician Plumber Mechanical Roofer u) ` 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: , 1r'
Print NameQLL=JJLC]�s Signature r �i__ Date
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