HomeMy WebLinkAbout932 W DRAKE RD - APPLICATIONS - 12/23/2009City of
F6rt Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 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 appliSable information on he application. Incomplete applications will not be accepted.
Application # 091 Date IZ`�0q
For office use only
Job Site Address (required)
Value of Constructiontbor, materials, profit)
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7010117 S . o0
Property Owner Name Address
City/State Zip Phone
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Applicant Name Address
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City/State Zip o Phone
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Contractor Address
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City/State Zip Phone
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here ❑ Report
sales tax number is required by all contractors.
Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? ❑ Residential gLCommercial
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 XRetail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes No Ifyes, you may need to co to Hi one Preservation
If this is for a demolition permit, what year was the building constructed? co 'Ll�ClA
If prior to 1975, you will need an asbestos assessment to submit with this application.
Descri do of work 1 IW 3 6 U 7 % I %T
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*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcon ractors: List the company name or City of Ft Collins license #
Electrician 4 ber �I�Mechanical IMi titoofer _� Other
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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:
Print Name: SEAOt4ldtel Signature do.� Date
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