HomeMy WebLinkAbout4980 HOGAN DR - APPLICATIONS - 6/2/2015City of
F„�rrt Collins
Planning, Development &Transportation
281 N. College Ave P.O. Box 580
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 # e / ,5 v y=2 a 3 Date
For office use only
Sob Site Address (required) Value of Construction (labor, materials, profit)
Li �$� o �w fir, $
Property Owner NaMe
Address City/State Zip
Phone $
WO
Applicant Name
Address City/State Zip dyS��2�
Phone °—
Contractor hl Lic #
Address I:L- City/State yL- Zip
Phone 1A
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here
Report
sales tax number is required by all contractors
Are you paying with your trust account? ❑ Yes
❑ No
Is this a residential or comm�ercial project? NrResidential ❑ Commercial
If residential, is it: KI 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 50 years of age or more? ❑ Yes ❑ No 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: c1
Print Name: �� �`w � � Signature Date 2