HomeMy WebLinkAbout919 COULTER ST - APPLICATIONS - 8/21/2018 (2)Cit
F®r'�t C'.ollins
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
0 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 # Date 8/21/2018
Aor o>ilce use only ip i - n � r121a.
Job Site Address (required)
Value of Construction (labor, materials, profit)
919 Coulter St.
$ 6099.00 30L�
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 H& 1314 Webster Avenue
Fort Collins, CO 80524
493-3272
Contractor City of Ft Collins Sales Tax #
Are you paying taxes here or by report?
M Here ❑ Report
Sa/estaznumberisrequired byall contractors:
Are you paying with your trust account?
M Yes ❑ No
34734
Is this a residential or commercial project? W Residential O Commercial
If residential, is it: 0 Single Family Detached 8 Condo/townhome (single family attached) 0 Duplex
G Multifamily (apartment) IQ Garage
If commercial, is it: 9 Bank 8 Bar ❑ Church Q Hotel/Motel ❑ Medical office 9 Office ❑ Retail
❑ Restaurant 9 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?
Ypnor to 1975, you w/I/need an asbestos assessment to submit with this appllcation.
Description of
*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 #
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: _
Print Name: Dennis Shortfldge Signature Dennis Shortridge
Date
8/21/2018