HomeMy WebLinkAbout420 HUDSON CT - APPLICATIONS - 10/21/2019Fort of
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 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 ❑ Electrical Alteration ❑ Gas Lighter ❑ Gas LogW Heating Unit ❑ Lawn Sprinkler
❑ Mobile Home replacement ❑ Sewer Line ❑ 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 #_ N Date 101151ICI
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
30 S0
Property Owner Name Address
City/State Zip
Phone
. 17(0llw MRS
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Applicant Name Address
City/State Zip
Phone
Contractor Address
City/State Zip
Phone
SM WHO OR(] 111L s
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Contractor City of F. Collins Sales Tax #
Are you paying taxes here or by report?
V Here SL Report
Sales tax number is required by all contractors.
Are you paying with your trust account?
Yes ❑ No
Is this a residential or �c{ommercial project? fAResidential ❑ Commercial
If residential, is it: 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 (explai )
Is this building 50 years of age or more? ❑ Yes ,�I No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the uilding 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 company name or City of Ft Collins 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 riot valid until it has been paid and issued.
Applicant-
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