HomeMy WebLinkAbout932 W DRAKE RD - APPLICATIONS - 7/6/2010Fort 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) lectrical 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 appl�cjle information the application Incomplete applic ion will not be accepted
Application #T/ � % �' Date 7 �/ (�
For office use only
Job Site Address (required) Value of Construction (labor materials profit)
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Property Owner Nam Address
City/State
Zip Phone
Ap li t Na Address
City/State
Zip Phone
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Contractor Lic # Address
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 /nun1berIs uiredbyall contractors
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Are you paying with your trust account? ❑ Yes No
Is this a residential or commercial protect? ❑ Residential PiCommercial
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 ❑ Retail
❑ Restaurant X Other (explain) 017 STGV S�O,4 f P .
Is this building 50 years of age or more? ❑ Yes ❑ No If yes, you may need to con ct Historic Preservation
If this is for a demolition permit what year was the building constructed?
If pnor to 1975, you wrll need an asbestos assessment to submit with this application
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*If lawn sprinkler/backflow preventer must list licensed plumber If first time A/C must list licensed electrician
Subcontractors Lrst the company name or City of Ft Collins license #
Electrician Plumber _ Mechanical 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 andlaw$ regulating building construction I know that a
permit is not valid until it has been paid and issued / s j /
Applicant � Print Name �� 7O L Q Signature Date I/10