HomeMy WebLinkAbout6809 HANCOCK DR - APPLICATIONS - 6/13/2017Planning, Developkmant & 7raruportabo,
1 �lr����r�� 281 N. College Ave II P.O. Box 590
Fort Collins, CO BM4
n:2-0.-� Phone 970-416-2740 Fax 2?4 6131
OVER-THE-COUNTER PERMITO ONLY
1 % s application is to be used to apply for the following permits only (check all at apply). ❑ Air Corhditioh.1: h,
- • i oniolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ 3as Lighter L1 Gas Log
111,�.iling Unit ////0���Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Se r Une ❑ Photo -voltaic
❑ Water Line ❑ Wood/Pellet Stove (must be EPA ce tiled, provide make mrida1 ,•
i wi mracturer )
r;uinnlete all applicable infom}ation on the application. incomplete appllcatlonsMrlll not bo accepted
V\apllcdtion K 1'3l 16 I� _ Date-
Fcr o/lfm use only
Jou Sate Addr fr.4u/r2A1
}� 009__an=
P h uty Owner Name
006kam-4.
i 6nhtiactor cityof R. Collins Sal" Tax #
,: r„,umrbrvrdvrrdedbra0mnohcmr:
valve of
Address City/State
city/State
nfol
Address my/stabe
i (labor, mateddls, plant,
Zip ?hone
__219-R51-d596
ZiippL/ Phone
ZIP Phone
Are you paying taxes here or y report? ❑ Here IdRepoi i
Are you paying with your amount? 19rYes ❑ No
is ti,hs d iesMduitlal or oommerdal 'project? PfilesIdentlal ❑ Commercial
r,ul,�illal, Is Itngle Family Detached ❑ Condo/townhome (single family
❑ Multlfamil� (apartment) ❑ Garage
i, oinunerdal, I•; It: ❑ Bank ❑!Bar ❑ Church ❑ Hotel/MobEd ❑ Medical office
❑ Restaurant ❑ Other (explain)
I mildhhq•50 years of age or more? ❑ Y,es []No Irye; you mayneed to i
,i : hs nir a derno:t lon perrnW, what year was the building constructed?
r, u to 1975, yvu will need an asbestos amemnent to submIt w/M t/[ls app/Icatlon.
i)•.j,r rhplion of work gernove -e4; 5tf&9 a-c-r -Co nG A -Hon -e-v
eerie( JYn5f A4 new ia.Ce.
If 1„wn s-prinkier/barkrow prevenO , must list licensed plumber. If first-time A/C, must list uorfhsed electrician
5..,xontractors: Liq der company name or Qry or Ft Cal/Ins AAnwse t'
at>affied) ❑ Uuplex
❑ C fficie ❑ Retail
onto ct Hlstolfc Prewrvatrnn
. ,_..viu,n- -- -- -• Number---•-- Med"czd------- Roofer-- i --- Wier -v- •-
„•her acknowledge that I (have read this appllcadon and state that the above information Is cpmplete and coned. t agree r..
..,iirly with all requirements contained herein and city ordhances and state laws regulating bulltling wnstrurtifoih. I krow that
•. emit Is not valid until It has been paid and issued.
uate