HomeMy WebLinkAbout4912 NINEBARK CT - APPLICATIONS - 6/26/2018Cityof Planning, Development & Transportation
} 281 N. College Ave P.O. Box 580
F6r` 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). M 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 ❑ 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 # E2 & 500/ Date
For office use only
6/26/2018
Job Site Address (required)
Value of Construction (labor, materials, profit)
4912 Ninebark Ct.
$ 2654.00
Property Owner Name Address
City/State Zip
Phone
Erick Drescher 4912 Ninebark Ct.
Fort Collins, CO 80528
493-3272
Applicant Name Address
City/State Zip
Phone
Erick Drescher 4912 Ninebark Ct.
Fort Collins, CO 80528
493-3272
Contractor Address
City/State Zip
Phone
DC Shortridge dba Gary Hil 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
&Aestax number isrequiredbyall contractors
Are you paying with your trust account?
M Yes ❑ No
34734
Is this a residential or commercial project? 8 Residential ® Commercial
If residential, is it: O Single Family Detached 8 Condo/townhome (single family attached) 8 Duplex
0 Multifamily (apartment) 8 Garage
If commercial, is it: B Bank B Bar ❑ Church 8 Hotel/Motel 0 Medical office ® Office 0 Retail
Cl Restaurant O 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?
Ifpnor to 1975, you will need an asbestos assessment to submit with this application.
Description of work Replacing AC with a 2.5-ton. 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 City of Ft Collins license #
Eectrician 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 Shortrid e
Print Name: g Signature Dennis Shortridge —' '" =""'" " Date 6/26/2018