HomeMy WebLinkAbout4615 HOGAN DR - APPLICATIONS - 10/27/2014Cityof Planning, Development & Transportation
F6r} 281 N. College Ave P.O. Box 580
r` Collins 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 V-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
Application # T>141 fxoo L.o
For ofce use only
Incomplete applications will not be accepted.
Date
Job Site Address (required)
Value of Construction (labor, materials, profit)
PropeOwner Name
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Address
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City/State Zip Phone
Applicant Name
Address
City/State Zip Phone
Contracts
Address
City/State Zip Phone
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?>9:�lere ❑ Report
Sales tax number is required by all contractors
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 ❑ Hotel/Motel ❑ Medical o ice ❑ Office El Retail
❑ Restaurant ❑ Other (explain) r/1 -
Is this building SO years of age or more? ❑ Yes ❑ No If yes, you may need to contact Historic Preseryation
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.
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Description of work t) 7::�11 L r-74T e�e4� EGG! ej4jr, 6x'a
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*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: ,cy/
Print Name: 0solL/ Signature Date /� ) r