HomeMy WebLinkAbout4425 HUMMINGBIRD DR - APPLICATIONS - 7/28/2014Planning, Development & Transportation
Cityof281 N. College Ave P.O. Box 580
Fort Collins Fort Collins, CO80524
Phone 970-416-27402740 Fax 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 # Date
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
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Property Owner Name Address
City/State
Zip
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Applicant Name Address
City/State
Zip
Phone Mo
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Contractor Address
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Zip
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Phone k)n
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Contractor City of Ft. Collins Sales Tax #
salestax number is re uiredby ad cono-aaors.
Are you paying with your trust account?
t�Yes ❑No
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Is this a residential or commercial project? 19 Residential ❑ Commercial
If residential, is it: 0 Single 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 may need to contact Historic 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 f iZ� a vtirly 2 'UC S i f S I I
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed PlP Tian.
Subcontractors: List the company name or City of Ft Collins license #
Electrician Plumber Mechanical Roofer 2 - Other
I 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. i know that a
permit is not valid until it has been paid and issued.
Applicant: //� ! '_
Print Name:y aT:J c Q i ie7�. Signature T Date