HomeMy WebLinkAbout4965 HOGAN DR - APPLICATIONS - 12/5/2016City of
/10`„F6 rt Collins
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
❑ 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 ontheapplication. Incomplete applicati ns wil> not be accepted.
Application # �V�1 1.�_-✓� Date / O
For office use only
Job Site Address (required)
Value ovonstructio%(labor, materials, profit)
7l D.
Property. 0 ner Name
City/State Zip
Phone
^ /Address
(\e f1 N1(jYC15 ` 4t_
0 1*
plicant Name Address
State Zip
Phone
IZISl`
s�(_L
Contra or l Address
�11
City/State Zip
I /r
Phone
iD
!/
—
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?/IiHere
❑ Report
5alestax number isrequiredbyall contractors.
Are you paying with your trust account. ❑��,,es
❑ No
Is this a residential or c mmercial project? Residential ❑ Commercial
If residential, is it: 4ASSingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel 9 Medical office'+ ❑ Off e ❑ Retail
❑ Restaurant ❑ Other (explain) .5���/I t,/%LT' 4'4a 0
Is this building 50 years of age or more? ❑ Yes ANo Ifyes, you may n e� d to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work 'S r
*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 not valid until it has been paid and issued.
Applicant: r `
Print Name: C1kcU natu a Date
f"? �v