HomeMy WebLinkAbout416 E DRAKE RD - APPLICATIONS - 7/20/2012Planning, Development & Transportation
Fort Collins Fort N. College Ave P.O. Box 580
Collins, CO 80524
Phone 970-41616-2740740 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 IrRoofing ❑ 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 # e?l 4,ioDate ` — Z-
For office use only )
Job Site Address (required) Value of Construction (labor, materials, profit)
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Property Owner Name Address
City/State
Zip
Phone
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Applicant Name Address
City/State
Zip
Phone
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Contractor LiiccJ# Address
City/State
Zip
Phone
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? 0Mre
❑ Report
Sales tax number is required by all contractors
Are you paying with your trust account? ❑ Yes
❑ No
Is this a residential or comm�ercial project? ❑ Residential ❑ Commercial
If residential, is it: ErSingle 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 ❑ Other (expla
Is this building 50 years of age or more? ❑ Yes in 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 this application.
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: List 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 and state laws regulating building construction. I know that a
permit is not valid until it has been paid and issued.
Applicant -
Print // n / /7
Name: ,c�LcY ! e� Signature 0h )rll er_ Date G yZ