HomeMy WebLinkAbout6126 CRANE DR - APPLICATIONS - 12/9/2019 (2)City of Planning, Developmen4 & Transportation Services
Fort C d1ins Community Development & Neighborhood Services
-- 281 North College Avenue
Fort Collins, CO 80524 Mn: 970.4162740 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 Lag
Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photoaroltaic
:❑ Ventilation ❑ Water Heater ❑ Water line ❑ Wood/Pellet Stave (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application #,
Date December 6, 2019
Job Site Address (requhsdq Value of Construction (labor, mateials, profit)
6126 Crane Drive, Ft Collins, Colorado 80528 $7349.00
' Property Owner Name Address Gty/Slab Zip Phone
David Kissel 6126 Crane Drive Fort Collins, CO 80528 970-207-1560
Applicant Name Address CKy/State Zip Phone
Christina Evans 1015 Link Lane Ft Co, CO 80524 494-7632
Contractor Address aty/State Zip Phone
Allen Service 1015 Link lane Ft Co, CO 80524 484-4841
Contractor City of FL Collins Sales Tax # Are you paying taxes here or by report? Mere ❑ Report
-Was tarnunberL-nWu Wbyaom�rx Are you paying with your tnat account? le wes ❑ No
10010
Is this a residential or gpmmeraal project? Residential ❑ Commercial
If residential, is it: VJ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Muffifanf%/ (apartrnent) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 5o years of age or more? ❑ Yes ❑ No lfyas, you nrayneed to carrtactH6t7ifcAeseba u7
If this is for a demolition permit, what year was the building constructed?
Description of work Pa em"rg faiaca "° repl= nth a Idx furnace
*If lawn sprinkler/baddlow preventer, must list licensed plumber, if first-time A/C, must list licensed electrician.
Srdr wbzcbors: List i6ectwnyname or01yofftCoIrzas%#
Bectridan Plumbs Medianlcal Roarer Other
I hereby acknowledge thatI have rod this application and state that the above information is complete and correct I agree to
comply with all reclulrements contained herein and oily ordinances and state laws regulating building construction. I know that a
perm t is not valid until it has been paid and issued. V/,�,
atll» CTw�t"uaa Evand Print �c7J t ,f ADam Date tz� J Print Name: Signature
firm bmdale?19QD17