HomeMy WebLinkAbout823 HILLDALE DR - APPLICATIONS - 12/15/2014city cvf
Fort Collins`'
Planning, Development &Trsnsportatloo
2B3 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 22+6134
OVER-THE-COUNTER PERMITS ONLY
This applic Won 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 Lotl
❑ Heating knit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Una ❑ Photo -venal;:
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood(Pellet Stove (must be EPA certified, provide make, m 5dei and
manufactuntr).
complete s.11 applicable Information on the application. Incomplete applications will not be accapteEl.
Applicatiol# pat �zic= —
Forotf5crttss orrlY
lob %S A fol'ess ( uireri)� Value of
I Pronerw oiuner NarnJ Address City/State
Applicant Nance` Address
Address
Contractor City of t. CollinsSaales Tax #
Sam tax nun &-r1sreatu1md bYatl combat Vff-
Cdy/State
i (labor, materials, pro fit)
7jp-- F'hune
lap Phone
7eq— /�/' -.lop
Are you paying taxes here or by report? ❑ Here i !rRel
Are you paying with your trust account? ❑ Yes ❑ No
Is this a re! lilantlal or commercial projecC? ,Residential ❑ Commercial
If r esiderrtS rl, Is it Single Family Detadted ❑ Condo/townhome (single family a0ached) ❑ Duplex
❑ Muilifamlly (apartment) ❑ Garage
If commercial, Is it: ❑ Bank El bar ❑ Church ❑ Hotel/Motel ❑ Medical office 17 Office ❑ Rhta11
0 Restaurant ❑ Other (explain)
Is this bulk ing 30 years of age or more? O Yes ❑ No If yes' yorr tray need to concoct Historic PAwewtb I
if this is for a demolition permit, vfltat year was the building canslrvcted?
if prior m .'975, you W/l/need an asbe Os assessment to submit w/tlr bh/s appllcad x
Pescriptjtn of work
*If lawn sp rmlder/bacidlow preventer, must list licensed Plumber- If first-time A/C, must list licensed eiecbician.
Saboold".ctors: L14t rde cnmpmyname ar Oky offtCo//ins 1k8r)W 0
Ele&dan_ Plumber Mechanlcar — Roofer J the
I Hereby acknowledge dull have read this application and state that the above Inronnatfon is complete and correct I agree, to
thmply wit 1.adl requirements contained herein and city ordinances and state laws regulating building construction. I k tow that a
permit is wt valid until It has been paid and issued. —.` 7
AppliGaid
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