HomeMy WebLinkAbout4128 SUMTER SQ - PERMITS - 1/20/2004Community Planning &Environmental Services BUILDING PERMITPERMIT
FEES
Building & Inspections Division
P.O. Box 580 281 N. College Ave.
Building valuation
Fort Collins, CO 80522-0580
city of Fort coins Phone (970) 221-6760 Fax (970) 224-6134 B 0 4 0 0 2 9 2
ACCOUNT
FEE
DATE PAID
JOB
SITE ADDRESS 4128 SUMTERSQ
PERMIT DATE
rr r, ",.' t 201 `)L' 4
Building Permit R(o Subs
City Sales/Use tax
County Sales/Use Tax
$15.0
$10.51
$2.8
1 i20/(14
1120f 04
1/20J04
PERMIT
TYPE
ELESER Electrical Service Change
PERMIT LEVEL
ISSU FUL
CATEGORY TYPE
Residential
Last Name, First, Middle Initial
NT
Construction Type
Occupancy Group
w
Address
City/State
p No. of Stories
Building Height
9 9
Z
34128
SUMTERFORT
COLLINS,o
Zip
Phone No.
Building Square Footage
Stock Plan/Options
O
80525-8462
266-8783
Front Setback
Rear Setback
Z
Right Side Setback
Left Side Setback
(See reverse side for Inspection Description)
F IN E E n
V
Plat File No. ZBA Case Number
Subdivision/PLID -
Zoning District
Filing
J
wLot
Block Lot Area Parcel No.
J
0
Name Contractor License No.
OCompany
V
Address City/State
H
Z
O
Phone Supervisor Cert. No.
Electrical License No.
- np f: rr?ntn r it n+
Mechanical
License No.
W
0
Roofing
License No.
H
Z
Framing
License No.
0
mZ)
Plumbing
License No.
N
Concrete
License No.
CHANGE OUT 16 CIRCUIT PANEL TO 40 CIRCUIT PANEL -CHANGE FROM 100 AMPS TO 150 AMPS
57<
PER 2002 NEC
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 permit shall become null and void if the work authorized by such permit is not
commenced,
suspended, abandoned or inspected within 180 days from the date of such permit or from the date of the last inspection.
z�-v
name of owner/age Signature " Date
TOTAL FEES
2 $,$
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