HomeMy WebLinkAbout621 REMINGTON ST - APPLICATIONS - 1/29/2016Jan 29 2016 11:44AM Gary Hooley Heat and Air 9702249198
page 2
FCity of
lirt CoL ins
Plataning, Development &Transportatlan
281 N. College Awe P,O, Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fox.224-6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (chock -all that apply). 0 Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
M Heating Unit D Lawn Sprinkler ❑ Mobile Home replacement O 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 # �� f Date 43r201I - 2 41 OW
For ofte use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
621 Remington
$2,075.00
Property Owner Name Address
Gty/State Zip
Phone
Kay Caspersen 350 McGraw Road
Friendsville, PA 18818
570-553-1689
Applicant Name Address
City/state Zip
Phone
Kay Caspersen 350 McGraw Road
Friendsville, PA 18818
570-553-1689
Contractor Address
City/state Zip
Phone
DS Shortride / Gary Hooleb 1314 Webster Avenue
Fort Collins, CO 80524
493-3272
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
W Here ❑ Report
&zbstax number IsrequlmdbyaNconAattm
Are you paying with you., trust account?
M Yes ❑ No
34734
Is this a residential or commercial project? 3 Residential ❑ Commercial
If residential, is It: 0 Single Family Detached ❑ Condo/townhome (single family attached) 9 Duplex
C3 Multifamily (apartment) ® Garage
If commercial, Is It: ® Bank ® ear ❑ Church ® Hotel/Motel G Medical office G office C3 Retail
Restaurant C3 Other (explain)
Is this building 50 years of age or more? ❑ Yes 0 No If yVs, you may need to contact Historic Pieser✓ation
If this is for a dernolilion permit, what year was the building constructed?
Ifpnbr to 1975, Kw will need an asbestus amassment to submit wflb this appflratlon.
Description of work J3eolace Fumace
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list ricensed electrician.
Subcontractors; L& the company name or Gty of Ft Collins licau" #
Sectriclan Plumber Mechanical H-1654 Roofer
Other
I hereby acknowledge that l 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 untll'it has been paid and issued.
Applicant: She
Print Dame; Shelly Swanson Signature
Date 11 J-711.q