HomeMy WebLinkAbout508 HUNTINGTON HILLS DR - APPLICATIONS - 12/26/2018Cityof Planning, Development, & Transportation Services
/,.Fort 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). ❑ 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 applicable information on the application. Incomplete applications will not be accepted.
Application #
zI-3IIa-ll
For ofAce use only
Date
Decewamrr 26, 2018
Job Site Address (required) Value of Construction (labor, materials, profit)
508 9a+iV"VZovt ha4D✓wve/ FortCoilxw, CO 80525 $350.00
Property Owner Name Address City/State ZIP Phone
MLchaeb1ZC tiler 508 IL LowliiU2 Dr Ft-CoUlny, Co- 80525 970-4I2-1272
Applicant Name Address City/State Zip Phone
Ch.rij "Utlicva*w 101 S Unk La.vt.e RCO; CO 80524 494-7632
Contractor Address City/State Zipp Phone
f UR4,L,Servi.cz 101 S LGnk Lanz Ft Co; CO 80524 484-4841
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑Mere ❑ Report
Sales tax number is required by allcontractora: Are you paying with your trust account? VYes ❑ No
10010
Is this a residential or Wmmerdal project? Y Residential ❑ Commercial
If residential, is it: 1E 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 ❑ No 1(yes, you mayneed to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the companynameorCity ofFtCollins license #
Electrician 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
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: Owsrv/wvEva u
Print Name: Signature Date
Revision date 21612017