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HomeMy WebLinkAbout4306 HUMMINGBIRD DR - APPLICATIONS - 7/10/201407/10/2014 12:44 3032962517 COEXTERIORS PAGE 02/02 City, of 281 N Planning,Development Ave p P.O. Box�rtation /„�! �, CQ��i11S Fort Collins, CO 80524 `, Phone 97"1&2740 Fax 224-6134 417 OVER-THE-COUNTER PERMITS ONLY I 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 replacementve 6&ofing ❑ Sewer Line ❑ Photo -voltaic ❑ Ventliation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet S (—must be EPA certified, provide make, model and manufacturer). Complete all applicable Information on the application. Incomplete applications will not a accepted. Application # YA H O-J-1,93 For ofte use only Date Job Site Address (raqul ) Value of Construction (labor, m ria d rt,t 10© Prope Owner Naps, A City/State Zip Phone A pliant Name Address City/State Zip Phone Cgptr ct�or , Address City/State ell Zip Phone Contractor City of Ft- Collins Sales Tax # Are you paying taxes here or by report? ❑ Here PQeport Saks tax numberlsrequ/red byaDmn&actorm Are you paying with your trust account? ❑ Yes ikimlo Is this a residential or mercial project? ❑ Residential El Commercial If residential, is It: Ingle Family Detached ❑ Condo/townhome (single family attached)' ❑ Duplex Multifamily (apartment) ❑ Garage If commercial, Is it: 13 Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office 17 Office ❑ Retail ❑ Restaurant O Other (explain) Is this building 50 years of age or more? 0 Yes o If yes, youmayneed to contattH/stor/cpreservatlon If this Is for a demolition permit, what year was thd building constructed? Ifpr/or to 1975, you wAl need an asbestas assessment to submit with this application, Of e— *If lawn sprinlder/backfiow preventer, must list licensed plumber. If first-time A/C, must list licensed decbiclan. Subcontractors: List dre company name or A'ty of Collins /!tense 0 A Etectridan Plumber Mechanical Roofer MN::/1j U/ Other I hereby acknowledge that I have read this application and state that the above information Is complebe 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. Appikant: Print Mama