HomeMy WebLinkAbout4213 HUMMINGBIRD DR - APPLICATIONS - 5/18/2015FROM RTC RESTORATION
(MON)MAY 18 2015 14:51/ST.14:48/Ho.7500000510 P 4
Fort Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
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) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit 0 Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellot Stove (must be EPA certified, provide make, model and
manufacturer),
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application #�d `y l Date
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al of Construction (labor, materials profit)
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Contractor City o . Collins Sales Tax #
Are you paying taxes here or by report?
d-lien? ❑ Report
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Are you paying with your mist account?
❑ Yes A -No
Is this a residential o commercial project? USLIZesidential ❑ Commercial
If residential, is it: Single Family Detached ❑ Cando/townhome (single family attached) ❑ Duplex
Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ church Q Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explV
is this building 5o years of age or more? O Yes o lfyes, you may need to wntactH/slnrrC Preselvaobn
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos asqrssment to submit with obis appllcabbn.
Description of ork cvt_' 21r,\ e► e, d
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*If lawn sprinlder/baCMow preventer, m list licensed plGmber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or Gty of R Collins license 0
Electrician Plumber Mechanical Roofer 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: �iC � 9 �il� Print name. / ��✓Si nature - _ Date �� l-s