HomeMy WebLinkAbout4105 Sumter Sq - Applications/Furnace - 12/08/2016Planning, Development & 7'ransporta'bon
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-1116 2740 Fax 224 5134
E COUNTER PERIVIrfS 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
Beating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
Cl Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA cer ified, provide make, modal and
manufacturer).
Coniplete all applicable information on the application. Incomplete applications will not be accepted.
Application i#)��� Date
For office use only
Sob Site Address (raquiredj Value of Construction (labor, materials, profit)
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Property Owner Name !!Address City/State Zip
( Phone
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A.)plicant Name Address City/State Zip
Phone
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Contractor Address City/State Zip
Phone
Are
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report?
El
c+.� irumbel'lsraquin�ibyall contractors Are you paying with your trust account?
I ❑ No
Yes
is this a residential or commercial project? ❑ Residential ❑ Commercial
it: GI -Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
if residential, is
❑ 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 Ifyes, you mayneed to contact HistoricPrese-vation
If this is for a demolition permit, what year was the building constructed?
Ir prior to 1975, you will need an asbestos assessment to submit with this application.
—j
Description of work
�`If lawn sprit !der/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
S.;bcontractois: Listthecompany name orCityofFtCollins license ;r
Plumber Mechanical - Roofer __ Other
t'lu�trician__ ,
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.: know that a
pernc is not valid until i!- has been paid and issued.
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