HomeMy WebLinkAbout420 RIDDLE DR - APPLICATIONS - 3/5/2019City of Planning, Development & Transportation
281 N. College'Ave P.O. Box 580
,,F6rt Collins 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). ❑ 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 Cl 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 # (�[°Id� 33 Date
For ofce use only
3/5/2019
Job Site Address (required)
Value of Construction (labor, materials, profit)
420 Riddle Dr.
$ 2966.00
Property Owner Name Address
City/State Zip
Phone
Walter Van Sickle 420 Riddle Dr.
Fort Collins, CO 80521
493-3272
Applicant Name Address
City/State Zip
Phone
Walter Van Sickle 420 Riddle Dr.
Fort Collins, CO 80521
493-3272
Contractor Address
City/State Zip
Phone
DC Shortridge dba Gary Ha 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
saies 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? IE Residential ❑ Commercial
If residential, is it i7 Single Family Detached 8 Condo/townhome (single family attached) 9 Duplex
❑ Multifamily (apartment) 8 Garage
If commercial, is it: ® Bank 8 Bar ❑ Church 8 Hotel/Motel ❑ 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 will need an asbestos assessment to submit with this application.
Description of work Replacing furnace with an 80% efficient 90K BTU gas furnace
*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. wmae,� —.s
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Applicant. Dennis Shortridge 0eI.11D3O 11:MM
Print Name: Signature ___ _ Date
3/5/2019