HomeMy WebLinkAbout1601 W Drake Rd - Applications/Mechanical - 10/01/2018 (6)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-vottaic
❑ 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 # P)1 (bi3c6 u.4A3 Date
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
Property Owner Name Address City State Zip Phone AM
Applicant Name Address City/State Zip Phone
Fort Collins Heating & Air 208 Commerce Or. #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 Is required by all contractors. Are you paying with your trust account? ■ Yes ❑ No
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 If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work
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*If lawn sprinkler/baddlow preventer, must list licensed plumber. If first-time A/C, must list licensed eiectri
Subcontractors: List the company name or City of Ft Collins 1/tense OF
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: ��pp
Print Name: Signature Date-to-1-01 113
Reviafe„date 20M17