HomeMy WebLinkAbout449 E DRAKE RD - APPLICATIONS - 8/26/201608/26/2016 FRI 10:32 FAX LINDS PLMBG & HTNG
12001/001
Flirt Cotfins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134 O Cj
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
R(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 applicable
�information on the application. Incomplete applications will not be accepted.
Application # U 0 5 1033 Date 1 _ (P
For office use only A aOt v
Job Site Address (required)
Value of Construction (labor, materials, profit)
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Property Owner Name Address
City/State Zip
Phone
OWnIS ACO* QU 6ox
2M R.Cot io1 , Co 1 522
Applicant Name Address
City/State Zip
Phone
1oi1�G tieGiilt It �(,:, 1�1`i 131U�' S ''lri� Dp.. 'Fj,%OL,._1%, Co oor�)2q
Contractor 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 4 Report
d No
Sales tax number is required by all contractors.
Are you paying with your trust account?
Yes ❑
Is this a residential or commercial project? 4 Residential ❑ Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) PyDuplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it:. ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes d No If yes, you inay need to contact Historic Preservation
If this is for a demolition: permit, what year was the building constructed? 010.
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work iUt2,tIaQ JAV IMtMei'lt
*If lawn sprinkler/backflow prev enter, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Coffins 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: c Jn (7�/x L� Date
Print Name: 1 J� C.i�im �/�.1��, Signature