HomeMy WebLinkAbout508 HANNA ST - APPLICATIONS - 6/25/2018City of planning, Development, & Transportation Services
F&t ColhnS 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 GI'Roofing ❑ Sewer Line ❑ Photo-vottaic
❑ 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 applicatio a will not be accepted.
Application # V 1�b SUO�� Date
For office use only
Job Site ddress (required) Value of Construction (labor, materials, profit)
fZb
Property Owner Name Address City/State Zip Phone
R0521 97/Y
Applicant Nam
Address City/State ZIP Phone
b2 � 5Zz1 � Mctl � 1i-�Q`�j C��I O
City/State Phone
( Address
r terr y1LA
Contractor City of R. Collins es Tax # Are you paying taxes here or by report? ❑ Here ❑Report
sales tax number Ls- Are you paying with your trust account? ❑ Yes ❑ No
s
Is this a residential or co ercial project? lta 6sidential ❑ Commercial I
If residential, is it: ingle Family Detached ❑ Condo/townhome (single family attached) ❑Duplex
❑ Multifamily (apartment) ❑ Garage SOA
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ other (explai
Is this building 50 yearsof age or more? ❑ Yes o Ifyes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed? -
of work
*If lawn sprinkler/bacidiow preventer, must list licensed plumber. If first-time A/Cr Must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license # 1�- Other
Electrician plumberMechanical Mechanical Roofer t
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 Nam
signature
Date 25
lls —
R,,islon date 202017