HomeMy WebLinkAbout4965 HOGAN DR - APPLICATIONS - 3/29/2016MAR-25-2016(FRI) 10:53 P.001/001
Ity of Planningr development & Transporc�ttiLion
Fort Collins 281 N. College Ave P.O. Box;po
Fart Collins, Co 8052,1
Phone 970-416.27R0 Fax 224.6134
OVER-THE-COUNTER PER ONLY
This apPllcatlon is to be used to apply for the following pennits only (check all that a I . Alr� nd)ti Wi
Demolition (interior non-slruetural) Electrical Alteration (not service change) Gas I-Ighler r� G�$ Logng
I-leating Unit Lawn Sprinkicr Mobile Home replacernent Roofing Sewer Line Phato--vigiialc Ventilation Water Floater Water Line WoodlPellet $love (mu;; t be EPA certified, provide rnake, model and
manufacturer).
Complete all at)plicable Information on the apPlication. incomplete applications will not be accented
AppIlea tion # b I v 0 ( I y
rvr W mr),
Address (Muirdd)
�roperty OwnerVitarnt: Address
I'YU'rr1S
Applicant Name Address
Dare
Value of Construction (labor,• materlals, profit)
,4567
City/5121te _ ZIP
6
City/stake ZIP Phone
Contractor Address Gty/state ZIP Phone
1i►lC-•`4VIZI.{ t=1��'L.l� '�.�P' I�tts(�.t�.1J�;y-{�7r* t>>~ �=.G�Gc: rot25Z�► �� �M�7�.'�'?t
Contractor or City of FL Collins Sales lax Are you paying taxes here or by report? Mere A
fox"urnbrrk�vulrrdbyallctxrtr� Are you paying with your trust account? Yes
r
is this a residential or comrnerc47 . pxj ? exldentla Commercial
If residential, is it: ngle Faml eras, Cando/townhome (single family attached) Duplex
Mu tiramlly (apartment) Garage
Jf cornmercial, is it: Dank Bar CNiurch- Motel/Motel Medical office Office Retail
Restaurant: Other (explain)
Is this bulfdinq SO years of age or more? ' Yes a y= you may" Cd to e�✓r 41THiSfOric t'r:Scrvstion
V this Is for a dernolition permit, what year was tit g constructed?
If prior to t9i5, you will need an ,asbelr�s aCssmcnr to submfr with rhrs applinarr.
os=
if lawn sprinkler/backflow preventitr, must list lieeh5ed plumber. tf iiir+t'dmE µ/C, must bet licensed electrician.
Subao nt:r rs: ,List d a company n.rrue or Co off? Cotrns !wins r
Electrician _ Plumber � Mr_ChSnICb)
Roofer Other
I hereby acknowledge that f Itlrvr. read this application and smce' that the above information is complete and correct. I agree to
complt► with all requirements contained herein and city ardlnancee. and,, laws regulating b�11, construction.
pertttitr is notvalid until it has been pard and Issued. fe r+ g e' know xhat a
Applicant:
Print Namet Y •Vvl�7 ' Slvnat;ure f