HomeMy WebLinkAbout415 RED HAWK DR - APPLICATIONS - 12/4/2018City of_
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Planning, Development & Transportation
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This application is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (noXlimust
ce change) ❑ Gas Lighter El Gas Log
D Healing Unit ❑ Lawn Sprinkler ❑ Mobile Home replacemenRoofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet S be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not accepted.
Application # ? \ q) `
For ofike use only
]ob Site Address (requited)
�m Dr
Value of Construction (labor, materials, profit)
dp
15
13 q3 - 00
Property Owner Name Address City/State Zip
lYi 9- fi 0 415 ed+1AAJ*-I Cofll'hs
Phone
170462 17g3
APPYWnt Name Address
ac�'�'
_ City/State Zip
j b *-
Phone
-121) 54/ 199
clan r-
o r
Contractor Address
4 �78/0)e ajora-do Lie-
City/State Zip
7 //T35fal
Phone
Contractor City of Ft Collins Sales Tax #
Are y u paying taxes here or by report?
Here ❑ Report
salw il ir n=berIFfaWmdbyall =badors.
Are you paying with your trust account? ;tYes ❑ No
Is this a residential or cpmmerdal project? Residential 11 Commercial
If residential, is It: ASIngle Family Detached ❑ Condo/townhome (single family attached) 17 Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant G] Other (explain)
Is this building So years of age or more? M Yes ❑ No If yw, you mayneed to contactHUmic Pires,°wvabbon
If this Is for a demolition permit, what year was the building constructed?
Yprlorto 1975, you w111 need an asbestos assessment to submit with this appllmG'on.
Descri nt
ion of work
*If lawn sprinider/baddlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List Me company name or LXy of Ft Collins Ikense 0
Medridan 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
compty 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: � ~ jJ�f� r� G+ � �
Print NeL /I SG� M (Signature Date 1� /
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