HomeMy WebLinkAbout419 E DRAKE RD - APPLICATIONS - 7/2/2014Jul02 1401:33p ACE HI PLUMBING& HEATING
970-278-1490 p.1
of
Fort 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 P Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ sewer Line ❑ Photo -voltaic
0 Ventilation ff Water Heater O 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 # 51 4-0�[,OU . Date i ' t jq
For office use only
Job Site Address (required)
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Value of Construction (labor, materials, profit)
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Property Owner Name Address
CityJState Phone `'777c
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Applicant Name Address
City/State Zip Phone
Contractor Address
City/State Zp Phone
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? 4D I ere ❑ Report
SWestax number js;requredbyaumntracmrs.
Are you paying with your trust account? ,12 fes ❑ No
Is this a residential or commercial project? .- rResidential ❑ Commercial
If residential, is it: -0 Swingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church L] Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
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?
If prior to 1975, you will need an asbestos assessment to submit with thLs application.
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company na e or City of Ft Collins license #
Sactrician Plumb 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 and state laws regulating building construction. I know that a
permit is not valid until it has been paid and issued.
Applicant:
Print Nam
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