HomeMy WebLinkAbout6020 HUNTINGTON HILLS DR - APPLICATIONS - 10/10/2017 (2)FCity of P/ann/ng, Development, & Transportation Services
ort Collins 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). 10 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 appli0cabblle Information on the application Incomplete applications will not be accepted
Application #_ 6vk Date n.� • `
Forofice use only
]ob Site Address (naqulmd) Value of Construction (labor, matenals, profit)
C I I I c 2 �
Property Owner Name 0 Address City Sta 1 Zrp Phone g1e)
1� 5
Applicant Name Address City/State Tip 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 0 Report
Saks taxmmberIs/Wt&edbya#wMacrols Are you paying with your trust account? 0 Yes ❑ No
Is this a residential or commercial project? 14 Residential O 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 ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes 'oNo If yes, you may need to contact H/stonc Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work
*If lawn sprinkler/baddlow preventer, must list licensed plumber If first-time A/C, must list licensed electrician.
Subcontractors: Ust the company name or Gty of Ft Collins license #
Elednoan 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 notvaliduntil It has been paid and Issued.
Applicant:
J p p b
Print Name. l" iC.('
Signature Date 1
RevuIM date 26 017