HomeMy WebLinkAbout1418 HIWAN CT - APPLICATIONS - 4/26/2017APR/26/2017/WED 02:20 PM
FAX No. P. 007
FoCity of planning, Development, & Transportation Services
rt Collins Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main. 970.416.2740 Fax: 970.224.6134
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OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply), Q 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 # B FITi °G S S Date
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
HH Fort o s S 05.? � 12. CJD
Property Owner. Name Address City/State Zip Phone
M �5 -Ta
Applicant Name Address City/State Zip Phone
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Contractor Address City/State Zip Phone
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C iL� I 1^ ICS �• ii/l2 S' {�}ZSsa�
Contractor City of Ft. Collins Sales Tax Are you paying taxes here or by report? ❑ Here ❑ Report
saleswxnumber 13rep�/raday i acmrr, Are you paying with your trust account? ❑ Yes ❑ No
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is this a residential or commercial project? O Residential 0 Commercial
If residential, is it: 12 Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel CI 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?
Description of work 10 it Y1
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Gst the company name or Crty of Ft Colllns license 9
Eledridan 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, �2)) Ia O SLI a) `Signature ti
Print Name: Date
Rands+ date M017