HomeMy WebLinkAbout6809 HANCOCK DR - APPLICATIONS - 6/19/2017Planning, Development & Transportation
olA y' � p $� For N. College
008Ave P.O. Box Ssu
i Fort Collins,es, CO 80524
sh
OVER-THE-COUNTER
qq�� ///piaa�y • • tea',} �pp �paY 88,�qq����pp Q���t �rgg ggppr,y��( Phhoon{¢C9►
e1199770•416-277400�AFgax 224-6131
i t.is application Is robe used to apply for the following permits only (check all that apply). ❑ Air Condidorrny
! DrmoAdon (interior non•atrucfuraf) ❑ Electrical Alteration (not service change) ❑ Gas Ughter ❑ Gas Log
Cl Heating Uniitt /// ❑ Lawn Sprinlder ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Une ❑ Photo -voltaic
Ci Ventilanon t�n�ter Heater Q Water line ❑ Wood/Pellet Stove (must be EPA certified, provide make. m•,dcl :i. id
11ianufacturer) `
Complata all applicable Information on the
%application. Incomplete applications will not be accepted
1R)
Application 1 "1 .0-%-•-
For aav use only
j Joo Sits Address freyuftd) Value of Construction (labor, materials, pror7t) ----
1 00
T
CoAb`L _—Lid h Y- Pxo 1 5. �P --��
Property Owner Name � Address city/State 21p Phone
Gonractor
Contractor city of FL Collins Salts Tax #
>dK rat ,rvmbwisraq&&vd by a0 mrMsatrrs
Address
Am, ra Co
Address city/Smabe
ap Phone
�-'ll_�
Zip Phone
Are you paying taxes here or by report? ❑ Here ZW;Ug
Are you paying with your mist amount? 1pes ❑ No
is rids a residential or �corpprnnerdal project? Blaslde %al ❑ Commercial
if reUdendal, is R: E(Single Fa(rttiy, Detached ❑ Condo/bownhorne (single family attadred) ❑ Uuplex
❑ Muitlfamly (apartment) ❑ (gage
if cuumerdal, is It: ❑ Bank ❑ Bar ❑ Church ❑ Hobel/Motel ❑ Medial ottlee ❑ office ❑ Retail
❑ Restau 4 ❑ Other (explain)
i is lus lurildlltg °50 years Gila ge r more? ClYes ❑ No Jrye4 )oumiayneed to contactHLstorlcFresmwbbn
ri tbls Is for a demolition perm what year was the budding constructed?
:. ranvfaJ975, you wh7needanasaestasassemnenttosub'7*10 rth/sePOWSon.
l Ikscription of work
Y G�1.4
U 16►41 —
If Ihwn WriiiWer/badcflow preventsr, must list licensed plumber. If first-time A/C, must list licensed elecMdan.
Su,cm,tractors: LLsr dra mmpmryname os 0W ofR Lb&w ffrense 9
Nadtanl®I _ Ro01pi -- Outer
�hv ackimWedge that I have read ft appnogtion and state that the above Information Is complete and torrent I agree ra -_
aiy:ty with all requirements contained herein and city ordinances and state taws regulating building construction. 1 know that e
;;1mtt is not valid until it has been paid and Issued.
AppltcaaU
pr!r.> Mar7r /! M , r A17 1 Wll ,naWrej Oats, ill �Cl I