HomeMy WebLinkAbout650 W Drake Rd - Applications/Furnace - 06/22/2018 (7).Fort Collins
Planning, Development, & Transportation Services
Community Development & Neighborhood Services
281 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-structuraq ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
N Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo-vokaic
❑ 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 # !Wo �14 (P Date
For offillne use only
]ob Site Address (required) Value of Coqptructlon (labor, materials, profs)
11 o,
Property Owner Name Address ity/State Zip Phone
IAI 3
Applicant Name Address City/State Zip Phone
Contractor} Address City/S tp Zip Phone
SUA
Contractor City of Ft. Collin les Tax # Are you paying taxes here or by report? ❑ Here ■ Report
53iesraxnumberisrequired bya#conbacfors�,n Are you paying with your trust account? 0 Yes ❑ No
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Is this a residential or commercial project? Residential ® Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) El Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ■ Other (explain) R)YUY ak "( L
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
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors. List the company name or Oty of R Collins /!tense 0
Electrician Plumber Mechanical am 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: 1I�( C
1
Print Name:' W V Ill SignaturebatelQ
Recision date 202017