HomeMy WebLinkAbout702 W Drake Rd - Applications/Air Conditioner - 05/03/2018 (3)Fort Collins Planning, Development, & Transportation Services
F,. Community Development Si Neighborhood Services
261 North College Avenue
Fort Collins, CO 80524 Main: 970.416.2740 Fax 970.224.6134
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 ❑ 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.alt applicable Information on the application. Incomplete applications will not be accepted.
Application Date
For office use only
]ob Site Address ftwubed) Value of structiOr (tabor, materials, profit)
Property Owner Name Address City/State Zip Phone
FA
Ap licant Name Address City/State Zip Phone
Y
Contractor Addis,ress (3 State Zip Phone d
,
Contractor City of if Colll les Tax # Are you paying taxes here or by report? ❑ Here Y Report
Sales tax mxzbffisre teIdbyspCp.3rtU,y_ t C Are you paying with your trust account? 5Yes 0No
Is this a residential or commercial project? J „ ❑ Residential Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
D Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office 7�11)Bioe ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No If yes, you may need to contact Historic pnservation
If this is for a demolition permit, what year was the building constructed?
Description of w rk C Q ,
*If lawn sprinkler/baddiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City ofFt Collins lkense #
Electrician Plumber.
Medianipl A�6Roofer 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 constriction. I know that a
permit is not valid until it has been paid and issued.
Applicant: 'r t�
Print Name. tt jl i{i�ISignature lt�� Date L� g
Revision dm 20M17