HomeMy WebLinkAbout636 HINSDALE DR - APPLICATIONS - 6/7/2018Pleoiniang, Development & Transportation
,. I t it cif- � 281 N W lege Aye P O Box 580
L} • ollin Fort Collins, 00 80524
Phone 970-416-2740 Fax 22+6134
t
E 0T - U T PERMIT$ ON�jk)AlrConclltionlng
This apnlicatlon rs to be used to apply for the following permits only (check ail that appl
❑ Op ,,,Ilion (intenor non-structuraQ ❑ Electrical Aitetation (not service change) ❑ Gas Llghs Log
1�3ahng Unit Q Lawn Spnnkier ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo-voltalc
❑ Venitlatlon ❑ Water Heater ❑ Watet Una ❑ Wood/Peliet Stove (must be EPA certified, provide make, model and
manufacturer)
Complete all applicable information on the application incomplete applications will not be accepted �---
Applicabon # ��, 000 L1 SO Date
For o/fice use only
Site
pjlcant Name$, l Address
Te Imo`- I
14#12"i'e
Addre is
Cosh acbor Oty of Ft Collins Sales Tax #
6% /gum I rdq 1 q fan coney- dw=
Value of
i pabor, materials, profit)
Zip Phone
MY/State 7up Phgne
V7
at),/State 7JR Pljonq
_ rtlJ'�1
Are you Raying taxes here or by report? ❑ Here' i
Are you paying with your trust account? 'Yes ❑
is this a residential or commercial project? Residential ❑ C061mercial
tF residential, is It ❑Single Family Deta 0 4 ondo/townhome (single family attadied) ❑Duplex
❑ Mvitl6mily (aparprr t) ❑ Garage
Ir commercial, is it ❑ Bank ❑ Bar ❑ church 0 Hotel/Motel ❑Medical office ❑ Off1ce ❑Retail
❑ Restaurant 0 6ber (,explain)
is this building 50 years of age or more? ❑ Yeg n No 1fyez yorimay need to aontactHlsWffcPreservatlon
If this is for a demolition perrnk what year was the building cons7ucted?
Ir Di for tv 1973, you will need an asbestos assessment to submit iWM this apPlfcatfon
I.lawn spnnkler/badcFlow preventer, must list licensed plumber IF fimb-time NC, must Ilst licensed electrician
Subcontractors UstthernnIpanynamaorGtyofRColllnsllcense,#
i FJactnuan_ —
Plumber Mechanical Roofer other
r hereby acknowledge that I have read iris application and staba that the above Information is complete and correct I agree bo
wmpiy with all requirements contained herein and city ordinances and state laws regulating building construction 3 know that a
permit Is not valid until rt has been paid and issued
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PpntNam el- )Ob i' el