HomeMy WebLinkAbout650 W Drake Rd - Applications/Furnace - 06/22/2018 (3)City of
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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
■ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater 11 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 #__ ?) � Yo LAI S 3 Date
For ofike use only
Job Site Address (requ/red) Value of Co truction labor, materials, profit)
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Property Owner Name Address Ity/State Zip Phone
Applicant Name Address City/State Zip Phone
Contractor Address City/State Zip Phone
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Contractor City of R. Collin ales Tax # Are you paying taxes here or by report? ❑ Here ■ Report
_%Iestax number lsrequlredbyall contradors lq(2O Are you paying with your trust account?. ■ 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) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank 17 Bar ❑ Church q Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ■ Other (explain) FQY\LtakDAA
Is this building 50 years of age or more? ❑ Yes ❑ No If yes, you may need M contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work Y
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time AJC, must list licensed electrician.
Subcontractors: List the company name or aty of Ft Collins //tense #
Electrldan Plumber MechanicalRoofer 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: 1 (+
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Print Name. IllM*14k
eV Signature Date
Re sow date 2A M17