HomeMy WebLinkAbout4144 SUMTER SQ - APPLICATIONS - 2/6/2014City of Planning, Development & Transportation
�1` 281 N. College Ave, P.O. Box 580
i Collins` Fort Collins, CO 854
Phone 970-41616-2740Fax 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 ❑ 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 # T lgOb'C�4c)
For office use only
Date 2 . Z Lu
lob Site Address (required)
Value of Construction (labor, materials, profit)
Property Owner N me
Address
City/State Zip
Phone
G�oo�
Applicant Name
Address
City/State Zip
Phone
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Lo L��, a� (30 '5z�
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Contractor
Address
City/State Zip
Phone
05
Contractor City of Ft. Collins Sales Tax #.
Are you paying taxes here or by report? ,Mere ❑ Report
Sales tar number is required by all contractom
,7
Are you paying with your trust account?
❑ Yes 17 No
Is this a residential or commercial project? ❑ Residential ❑ Commercial
If residential, is it: mgle 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 contactH/storic 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.
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name orCi fFitCollins/icense#
Electrician Plumber ZE Mechanical Roofer Other
I hereby acknowledge that I have read this application and state that the above
comply with all requirements contained herein and city ordinances and state law
permit is not valid until it has been paid and issued.
Applicant:
Print Name: T Signature
is complete and correct. I agree to
building construction. I know that a
Date ���(