HomeMy WebLinkAbout4149 SUMTER SQ - APPLICATIONS - 8/27/2014Aug.27.2014 10:18 AM 5 Star Home Improvement I 9706637827 PAGE.. 2/ 2
CL
City ®� Planning, Development & Transportation
FY 281 N. College Ave P.O. Box 580
ort Collins Fort Collins, CO 80524
/'"O� Phone 970-416-2740 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) 0 Electrical Alteration (not rvl change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit O Lawn Sprinkler ❑ Mobile Home replacement foust
ofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater CI Water Line ❑ Wood/Pellet Stove be EPA certified, provide make, model and
manufacturer).
Complete all applicable Information on the application.
Application # , I Li
For oAfte use only
Incomplete applications will nOt'be accepted.
Date
fob Site ss requ/re M� �� ���Value of Conryletlon� (�r materials, profit)
Ca (!X/--If 1
P o Owner Na e� i A'O A dr (� (� C�ty/State 1lZ,ip
.liltW V 1 J �< ��' tU�
Phone
pli nt Na Ve(d
gim
r s S to zip Ao
'
Phone
r
IM
jQontractor � �Addrgss�a� � Ciry/$fate � Zip 91D���
OG�i��i r 1fLeUnyouUnp/anyYinnllg
3-33
Phone ��
Contractor Ci of Ft. Collins Sales Tax #
Safes tax numbarIsrequ/red byallwntractors
,A taxes here or by report? ❑ Here
' Are you paying with your trust account? I;R:Yes
❑3 Report
❑ No
Is this a residential o commercial project? esidintial ❑ Commercial
If residential, is It: Single Family Detac ed , r3 Condo/townhome (single family attached) ❑ Duplex
Itifamily (apartment)' ❑ Garage
If commercial, Is It: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
El Restaurant ❑ Other (exKla')
Is this building 50 years of age or more? ❑ Yeso If yes, you may need to contact H/sinr/c Preservation
If this Is for a demolition permit, what year was thilding constructed?
If prior to 1975, you will need an•asbestos assessment to submit with this application.
Description of work
lawn sprinkler/backflow preventer, must
, If first-time A/C, must list licensed electrician.
Subcontractors, List the company name or Cly of Ft Collins license 0
Eladridan Plumber flechanite Roofer
Other
I hereby acknowledge that I have read this appliotion and. state thpkthe above Informatlop Is complete and correct, I agree to'
comply with all requirements contained herein and city ordina'nii and state laws regulating budding construction, I know that a
permit is not valid until It has been paid and Issued. /1�]
Applicant -
Print
Print Name: Signature