HomeMy WebLinkAbout6020 HUNTINGTON HILLS DR - APPLICATIONS - 10/4/2017FCityof Planning, Development, & Transportation Services
o t Cothns 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). 14 Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replac
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pe
manufacturer).
Complete all applicable Information on the application.
Application # v V
Fo ce use only
ement El Roofing ❑ Sewer Line ❑ Photo -voltaic
llet Stove (must be EPA certified, provide make, model and
Incomplete applications will
not be accepted.
Date
Sob Site Address (requlred) Value of Construction (labor, materials, profit)
1-li I vD w5b
Property Owner Name Address C
ity Sta Zip Phone ggt7
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Applicant Name Address 0 City/State Zip Phone
Fort Collins Heating & Air 208 Commerce Dr. #4 Fort Collins, CO 80524 970.484.4552
Contractor Address City/State Zip Phone
Fort Collins Heating & Air 208 Commerce Dr. #4 Fort Collins, CO 80524 970.484.4552
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here � Report
Sales tax number isrequIred by all con&actors Are you paying with your trust account? 0 Yes ❑ No
Is this a residential or commercial project? t4 Residential ❑ Commercial
If residential, is it: IX Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office 0 Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes 'oNo 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
*If lawn sprinkler/bacldiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license ,#
Electrician Plumber Mechanical H1309
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: p r�
Print NameI. 1 ` & Signature ` Date 1
119
RemimdateM 017