HomeMy WebLinkAbout435 E DRAKE RD - APPLICATIONS - 2/14/2018 (3)FCity of Planning, Development, & Transportation Services
ort Collins 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
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 0( 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
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Application # ,l ( h Date
For ofte use only
to Site Address (fequned) Value of Construction (labor, materials, profit)
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Property Owner Name Address Gty/State Zp Phone
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Applic�tit Name Address City/State �JZriip Phoneg7e)-ZZj
Contractor //p Aldress City/State Zip Phone
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Contractor City of Ft Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
Sales tax number Is required by allmncactufs Are you paying with your trust account? ❑ Yes ❑ No
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Is this a residential or commercial project? Residential ❑ Commercial
If residential, is it' ❑ Single Family Deta ed ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) M 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 morel ❑ Yes ❑ No If yes, yvu may need to contact Hrstonc Preservadon
If this is for a demolition permit, what year was the building constructed?
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*If la n sprin r/mow preventer, must list licensed plumber If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or Qty offt Collins license #
Bectician 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 Mn 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: / �J
Print Name � L.() Signature '? pate /� /
RevidM date ZSM17