HomeMy WebLinkAbout650 W Drake Rd - Applications/Air Conditioner - 06/26/2018 (6)„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
❑ 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) \ b V "105cl Date
For ofJ`Icr use only
Job Site Address (required) Value of Co ructlon labor, materials, profit)
Property Owner Name Address ity/State Zip Phone
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Applicant Name 1l Address City/State Zip Phone
Contractor Address City/5 to Zip Phone
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Contractor City of R. Collin les Tax # Are you paying taxes here or by report? ❑ Here ■ Report
Sa/estarnumberismpuhedbyall av*acf=aq O Are you paying with your trust account? i 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 Mar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ■ Other (explain) Fl)MYCA "DN
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
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*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Ust the company name or aly of Ft Collins license
Electrician Plumber Mechanical—atm 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: ”.
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Print Name:�J11 tY�
U f(l& Signature Date
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