HomeMy WebLinkAbout6025 S SHIELDS ST - APPLICATIONS - 4/20/2017Of Planning, cweiopment tk -i ransportatton
FliCity 281 N. College Ave P.O. Box 580
rt ` shins Fort Collins, CO 80524
'Q�.. Phone 970-416-2740 Fax 22461M
OVER-THEnCOU TER 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 ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Mod/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable
eiinformation on the application.
f
Application # k I� O � jI V
For ofte use only
Incomplete applications will not be accepted.
Date 4/20/17
Job Site Address (rwubed)
Value of Construction (labor, materials, profit)
6025 S. Shields Street
$100.00
Property Owner Name
Address
City/State Zip
Phone
Jamie Gulley
6025 S. Shields
Street Fort Collins Colorado 80526
970-290-4904
Applicant Name
Address
City/Statie Zip
Phone
Busse I Go ski n
1 -1 4o O
r Axi e Gre e1 e CL) SW O
322, 2S 2D
Contractor
Address
City/State Zip
Phone
AKDY-Aablc ;e402, AIL
L;c# to
-1141 SAPrI%AE -- --
223 - ILI33
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
JK Here ❑ Report
Sales Wnumber isrequkedbyall con&adom
ygy -1 -1
Are you paying with your trust account?
❑ Yes I. No
Is this a residential or commercial project?
If residential, is it: ❑ Single Family Detached
❑ Multifamily (apartment)
If commercial, is it: ❑ Bank ❑ Bar ❑ Chun
❑ Restaurant
Residential Rf Commercial
❑ Condo/townhome (single family attached)
❑ Garage
h ❑ Hotel/Motel ❑ Medical office 10 Office
❑ 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?
If prior to 1975, you will nerved an asbestos assessment to submit with this app/rcabon.
❑ Duplex
❑ Retail
Description of wow ras pressure test.
�P1�L14C � IpI S;
*If lawn sprinkler/baddfow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the conloany name or city of Ft Coffins lkaose #
Electrician 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 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:
Print Name:/( 0 (9� I �7 Signature
Date 4/20/17