HomeMy WebLinkAbout650 W Drake Rd - Applications/Furnace - 06/22/2018 (8)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-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
4 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 # 0"U S9L— Date
For olf)re use only
Job Site Address (required) Value of CoIrruction (labor, materials, profit)
> 0,
Property Owner Name Addreesss� City/State Zip Phone
yy
z
Applicant Name Address City/State Zip Phone
i'
all Y i Q # CD
Contractor Address City/St to Zip Phone
` r
Contractor City of Ft. Collins' les Tax # Are you paying taxes here or by report? ❑ Here ■ Report
Sales raxnumber tsrw0edby311 nrracroman D 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 0 Other (explain) FUYUYG.k� 'Y��
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
I
*If lawn sprinkler/bacldlow preventer, must list licensed plumber. If first-tlme A/C, must list licensed electrician.
Subcontractors: Ust the company name or aty of R Collins license #
Electrician Plumber Mechanical 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: C
Print Name:, W �'C V 111 Signature Date
ROVISIM data 2A=17