HomeMy WebLinkAbout415 E DRAKE RD - APPLICATIONS - 12/24/2014City of
Flirt ColtiIIS
Planning, Development & Transportation
261 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-116-274O Fax'224.6134
OVER^THE-bOUNTER PERMITS ONLY
This application is to:be .used to,apply for;the following permits only (check all that apply), Ll Air Conditioning
❑ Demolition (interior nOn-structural) Q. Glech ical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ L,aven Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater 0 Water Line . ❑ VVood/Pellef Stove (must be EPA certi[ed, provide make, model and
manufacturer). J.
complete all applicable �.
lnrtidmatioii bio tlje application, Inconrti•leto applications will not be accepted.
Application iLp . "� �O✓�1' Uate•__, I �' -- _-_
/-or.orflrn use onry
7 b Site Address (re /bitmU — value of Sonstruction (labor, materials' profit)
1•raee:)?d a��a
Property Owjier Nome. Address City/Slate Zip
W. 0-- tr_
Phone
Applicant Name ' Address City/Stil:e Zi(j Phone
�G� y 9
Contractor City/Stale Zip
Phone
Contractor City. of Ft..Collins.56les Tax /r '. ' Are you '0a g taxes here or by.report?
❑ Mere ❑ Report
s,72s h>rnumG� Is gbnr 1p7y! Cap. W.-.,. Are you praying wlth.your trust account?
.d Yes ❑ No
Is this a residentiail cr�,•4�dr iercial project? „�esidcntial ❑ Commercial
If residential, is it:. e2l�sin6ie Family Detached ❑ Conclo/townhprn6 (single family attached) 0 Duplex
C KUIGfrrnOy (apartment) ❑ Garage '
If commerclal,:is ip;•. ❑ 1.hrwnk 0 liar ❑ Church ❑ Flotel/Motel ❑ Medical office ❑ Office ❑ Retail
C1 Restaurant ❑ Other (explain)
Is this building 50 gears of age or shore? ' ❑. Yes ❑ No !Eyes, yjp may need to coiOct Hislo%/c Nre;servetioir
If this Is for a demdlition,loerniit, what year was the building cot' Icted? _
b`prior• to X975 you AVili n, (d<�h'as(icy(os assessment to subnt/t lVllrm (dlis'vniJ//Callon. -- -- "
Description of work
"'If lawn sprinkler/backflovY reveiifcr, must lht•licensed plumber. Ir flrst-timc'AJC, must list licensed elodrician.
Subcontractors: (ist(ltecompaiiYiHmeor,LYtyofFp(hl/lgslicense.
Clertri[Inn^- nlLfiibei••
Roofer __.. Other_��
I hereby acl,
comply with
pennit is n
Applicant:
Print Nam
that I liayeread this applicidon and state that the jto Information Is con?olete and correct I agree to
nidnti contained herein.'and city ordinances and spite knvs regulating build:r:q cunstruction. I know thaw
nut it has:beon paid and issued.
Date