HomeMy WebLinkAbout4152 Sumter Sq - Permits/Furnace - 10/08/2003Community Planning &Environmental Services
FEES
Building & Inspections Division BUILDING P E RM I TPERMIT
P.O. Box 580 281 N. College Ave.
Building valuation
i Fort Collins, CO 80522-0580
Citv of Fort Collins phone (970) 221-6760 Fax (970) 224-6134 B 0 3 0 6 6 1
ACCOUNT
FEE
DATE PAID
JOB
SITE ADDRESS
PERMIT DATE
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ou 1, 1111 ng Permit wlo Suus
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PERMITTYPE
PERMIT LEVEL CATEGORY TYPE
MECH Mechanical Alteration ISSU FUL I Residential
Last Name, First, Middle Initial Construction Type Occupancy Group
u1
3
Address City/State wp No. of Stories Building Height
zip Q
P Phone No. Building Square Footage n I Stock Plan/Options
80525-3464 225-2926
Front Setback
Rear Setback
Z
Z
Right Side Setback Left
Side Setback
•
N
•
Plat File No. ZBA Case Number
Subdivision/PUD
Zoning District
Filing
(See reverse side for Inspection Description)
u L f N M
J
wLot
Block Lot Area Parcel No.
7 I i3017
0 87371411
Company Name Contractor License No.
o'
0
QAddress
2�
City/State
ZZ
Phone Supervisor Cert. No.
U
Electrical License No.
W
Mechanical
License No.
C
FXCEI HIG,HOITINP,u
1451
Roofing
License No.
F-
Framing
License No.
Z
0
U
Plumbing
License No.
ca
Concrete
License No.
REPLACE GAS FORCED AIR FURNACE
V
As
a condition for the issuance of a permit, I hereby declare that I am an owner or the owner's agent, authorized to perform the proposed work on the property
described
herein. I agree to comply with all City ordinances, and State laws associated with such work. I understand that such permit may be revoked in the
event
that issuance was based on incorrect or incomplete information. This per t shall become null and void if the work authorized by such permit is not
commenced,
suspended, abandoned or inspected within 180 days from the d of suc it or from the date of the last inspection.
LI� � y -8 -03
TOTAL FEES
5
Print
name of /agent Signature Date