HomeMy WebLinkAbout650 W Drake Rd - Applications/Air Conditioner - 06/26/2018 (4),FCity of Planning, Development, & Transportation Services
ort Collins 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). N 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 #��1�J 1 Date
For office use only
Sob Site Address (required) Value of Co uction (labor, materials, profit)
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 Clty/S be Zip Phone
Contractor City of Ft. Collin les Tax # Are you paying taxes here or by report? ❑ Here ■ Report
'blestax number isrequiredbya#conaactois.ac O 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) Ell Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ office ❑ Retail
❑ Restaurant ■ Other (explain) TAJYUYCL� J M
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 ol 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 Q'ty of R Collins license
Electrician Plumber Mechanical —am Roofer Other
I hereby acknowledge that I have read this application and state that the above Information is complete and wmect 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 Print Name: �\1 I1� U i i I Signature \ 1 v` Date
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Revisim Gale 2 M17