HomeMy WebLinkAbout4306 HUMMINGBIRD DR - APPLICATIONS - 12/22/2015DEC-21-2015 04:38PM FROM -
9704848354 T-058 P.001/001 F-002
Fort Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-41&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) E3 Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation Cl 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 #
t1515 08 sq'�
For office use only
Date to - as - 16
Job Site Address (required)
Value of Construction (labor, materials, profit)
4306 Hummingbird Dr. 80526
$545
Property Owner Name Address
City/State Zip
Phone
Andy Brown 4306 Hummingbird Dr. Fort Collins, CO 80526
(206) 715-0610
Applicant Name Address
City/State Zip
Phone
Fort Callins Heating anti Air 208 Commerce
Dr. #4 Fort CollinS, C0 90524
4 305-3478
Contractor Address
City/State Zip
Phone
Fort Collins Heating and Air 208 Commerce Dr. #4 Fort Collins CO 80524
970 4844552
Contractor City of R. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here ❑ Report
Sa/estaxnumber isWjj#abyall cvnbadws
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or commercial project? Residential ❑ Commercial
If residential, is it: A-Bingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
13 Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar 0 Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ONO If yes, you may need to contact Historic Preseryatlon
If this is for a demolition permit, what year was the building constructed?
Yptior to 197S, you will need an asbestos assessment to submit with this appllcatlon.
Description of work run new gas line
*If lawn sprinkler/baddbw preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: L&thecompanynameorCity ofFtColl/nslicense.0
Electrician Plumber Mechanical H1309 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:
Print Name _Angela Morrow Signature �Y pate 12/21/2015