HomeMy WebLinkAbout435 E DRAKE RD - APPLICATIONS - 2/14/2018 (2)ALA �
Fort Collins
Planning, Development, & Transportation Services
Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main 970 416 2740 Fax 970 224 6134
OVER-THE-COUNTER PERMITS ONLY
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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 Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Sto a (must be EPA certified, provide make, model and
manufacturer)
Complete all applicable inforon the application. Incomplete applications will not be accepted
Application # 1 matio IN O lV 1 W Date n Z 1 41 e)
For ofte use only
)ob Site Address (requrred) I Value of Construction (labor, materials, profit)
5- -Q VA Lt 3�e 2,(04.ne
Prope Owner Name Ad ress City/State r, Zip Phone 3b3-
4qS r c ' roi / l' i' S 30
App11 t Name Address City/State Zip Phone Ct 7V-
`Lo\l i cw S S J-"61IR 2 e Ale zzt) F / ) 'aSzS
Contractor Address City/State Zip Phone
Contractor City of Ft Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
Sales taw tkw �� bya/rmnbacYws. Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial pro]ect7 R Residential ❑ Commercial
If residential, is it: ❑ Single Family Detadied Condo/townhome (single family attached) /0 Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it. ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (Jlain)
Is this building 50 years of age or mores ❑Yes Jp No If yes, you may need to contact NaYnnc Pres�rvadon
If this is for a demolition permit, what year was �e building constructed?
Description of work 2 ( f) S c
f 2 a t 2 5
*If lawn dnlder/bacldiow preveWter, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Ust the company name or city of Ft Co//ms Ixense #
i]ecMdan Plumber Mechanical Roofer ac t K"er
I hereby admowledge 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: /h
Print Name ash D l ` Signature pate
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