HomeMy WebLinkAbout1601 W Drake Rd - Applications/Mechanical - 10/01/2018 (5)�FCity of Planning, Development, & Transportation Services
o t Collins Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main: 970.416.2740 Fax: 970.224.6134
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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 # B I iOl �A 0 Date
for oHicr use only
lob Site Address (required) Value of Conduction (labor, materials, profit)
Property Owner Name Address city State Zip Phone
Applicant Name Address City/State Zip phone
Fort Collins Heating & Air 208 Commerce Dr. #4 Fort Collins, CO 80524 970.484.4552
Contractor Address City/State Zip Phone
Fort Collins Heating & Air 208 Commerce Dr. #4 Fort Collins, CO 80524 970.484.4552
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ■ Report
sales tax number isrequrrcdbyall mnoactws, Are you paying with your trust account? ■ Yes ❑ No
NON
Is this a residential or commercial project? ❑ Residential ■ Commercial
If residential, is it: ❑ 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 Ifyes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work
*If lawn sprinkler/baddtow, preventer, must list lic nsed plumber. If first-time A/C, must iist licensed electrician.
Su bcontractom: List the company name or city of Ft CoRns ikense #
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: Ll Signature Date
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Revision date 2AS12017