HomeMy WebLinkAbout611 HINSDALE CT - APPLICATIONS - 6/20/201818R372
City
*of Planning, Development & Transportation
281 N. CoAve
F6r` Cotti1 r� IS Fort Co I nls, CO 80524 P.O. Box 580
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). ❑xAir Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
0 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 # +) I V VLAq V 1 Date 06/20/18
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
611 Hinsdale Ct Fort Collins 80526 7323.71
Property Owner Name Address City/State Zip Phone
Matt Peters 611 Hinsdale Ct Fort Collins, CO 80526 970-217-0896
Applicant Name Address City/State Zip Phone
Contractor Address City/State Zip Phone
IMS Heating and Air 5213 Longs Peak Rd, Unit A Berthoud, CO 80513 970-532-0123
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
Sales taxnumber isrequired byall contractors . Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? ❑ Residential ❑ Commercial
If residential, is it: 13 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 If yes, you mayneed to contactHistoric Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
*If lawn sprinkler/backfiow 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 fi
Electrician Eggers Electric 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:
Print Name: JAMIE DENNEHY
Date.