HomeMy WebLinkAbout3002 W Elizabeth St - Applications/Air Conditioner - 07/02/2019Cit
F®r'�t Conine
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). Ill Air Conditioning
❑ Demolition (interior non-structural) D 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 Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # 0,\Wk'17-4 Date
For office use only
7/2/2019
Job Site Address (required)
Value of Construction (labor, materials, profit)
3002 W. Elizabeth St. #10A
$ 3220.00
Property Owner Name Address
City/State Zip -
Phone
Sitzman-Mitchell & Co. 3500 John F Kennedy Pkwy # Fort Collins, CO 80525
493-3272
Applicant Name Address
City/State Zip
Phone
Darrow Clark 1314 Webster Avenue
Fort Collins, CO 80524
493-3272
Contractor Address
City/State Zip
Phone
DC Shortridge dba Gary Hia 1314 Webster Avenue
Fort Collins, CO 80524
493-3272
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
O Here ❑ Report
Sales tax number is required by allcon&actors.
Are you paying with your trust account?
M Yes Cl No
34734
Is this a residential or commercial project? 111 Residential El Commercial
If residential, is it: ❑ Single Family Detached 111 Condo/townhome (single family attached) B Duplex
❑ Multifamily (apartment) ® Garage
If commercial, is it: 0 Bank 8 Bar ❑ Church 11 Hotel/Motel G Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Ifprior to 1975, you w111 need an asbestos assessment to submit with this application.
Description of work Installing new 2-ton. 13SEER AC
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license #
t3ectridanA&M Electric Plumber Mechanical H-1654 Roofer
Other
1 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. o,,h,y,;,,,,,,°,M„s„�,,;,a,
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Applicant: Shortridge Lmoon
Dennis Shortridge WleMIM7 MM12 7/2/2019
Print Name: Signature - Date