HomeMy WebLinkAbout439 HOUGHTON CT - APPLICATIONS - 8/15/2018,FCity of Ppanning, Development, & Transportation Services
�Ort Collins Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main: 970.416.2740 Fax: 970.224.6134
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 servicechange) ❑ Gas Lighter ❑ Gas Log
5'
❑ 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 applicableinformationon the application.
Application # I� l1 � D 3L-
Far office use only
Incomplete applications will not be accepted.
Date _ b //5 11
Job Site'Address (required) Value of Construction (labor, materials, profit)
Ct br+ CD 11 -q Is
Property Owner Name Address City/State Zip Phone
on tcAn la d 4391 W- to LLSM5DIT 12- 35-1Oa7
Applicant Nam Address City/State Zip Phone
`2' !Zn i� At Ugw C0(-o z
Contractor Address City/State Zip Phone
-Z57-
Contractor City of Ft Collins f4es Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
Sales tax number isrequired byall mn&acmrs. Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or coT,m ercial project. 5esidential ❑ Commercial
If residential, is it: Dingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail n
❑ Restaurant ❑ Other (explai C
Is this building 50 years of age or more? ❑ Yes W'No If yes, you may need to contactHistoncPreservation
If this is for a demolition permit, what year was the building constructed?
Description of work �fG - *07 ^ C C
� a
*If lawn sprinkler/baddiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List d7e company name or City of Ft Collins license # r on l n
Bectrician Plumber Mechanical Roofer (. C 1 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. ,� j� 9 % !/
Print Name: w 1' � Signature Date _ I
Reunion d� vazon _ V