HomeMy WebLinkAbout650 W Drake Rd - Applications/Air Conditioner - 06/26/2018 (3)wort 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). 0 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 all applicable Information on the application. Incomplete applications will not be accepted.
Application # �J I �(4-1 3 Date
For office use only
]ob Site Address (required) Value of Coruction (labor, materials, profit)
1
Property Owner Name Address ity/State Zip Phone
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Applicant Name Address City/State Zip Phone
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Contractor Address City/State Zip Phone
Contractor City of Ft. Collln§51ales Tax # Are you paying taxes here or by report? ❑ Here ■ Report
Sales tax number isrequired byall mnaacmrr-a 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/town home (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ■ Other (explain) R7Y DYCX NhYh4
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 fist licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or aty of Ft Collins license 0
Electrician Plumber. Mechanical-" 1 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 valid4&1
until it has been paid and Issued.
Print Name:- 1.�U I r l Signature Date rr� ``
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RevWw date 2AV2017