HomeMy WebLinkAbout919 COULTER ST - APPLICATIONS - 8/21/2018Fort Collins
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). M Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
O Heating Unit 0 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 # Date 8/21/2018
For office use only
Job Site Address (required)
3 Value of Construction (labor, materials, profit)
919 Coulter St.
$ 6099.00 305-0
Property Owner Name Address
City/State Zip
Phone
Sarah Lacy 919 Coulter St.
Fort Collins, CO 80524
493-3272
Applicant Name Address .
City/State Zip
Phone
Sarah Lacy 919 Coulter St.
Fort Collins, CO 80524
493-3272
Contractor Address
City/State Zip
Phone
DC Shortridge dba Gary Hik 1314 Webster Avenue
Fort Collins, CO 80524
493-3272
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
0 Here ❑ Report
Sales tax number is required by all contractors.
Are you paying with your trust account?
M Yes ❑ No
34734
Is this a residential or commercial project? 0 Residential ❑ Commercial
If residential, is it: 0 Single Family Detached 8 Condo/townhome (single family attached) 0 Duplex
❑ Multifamily (apartment) 0 Garage
If commercial, is it: 17 Bank 8 Bar ❑ Church 8 Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant Cl Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No Ifyes, you may need to contactHistoric Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work
2.5-ion. 13SEER
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or Clty of Ft Collins license #
Electrician Plumber Mechanical H-1654 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: Dennis Shortridge - _,_
Print Name: Signature Dennis Shortridge 1'9= �,-- Date
8/21/2018