HomeMy WebLinkAbout609 STONEHAM CT - APPLICATIONS - 4/9/2019Fort 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
* 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 # N _I-N0 ftw) Date 4/9/2019
For office use only?) I lQ-�Ra ( Q A ( G
Job Site Address (required)
Value of Construction (labor, materials, profit)
609 Stoneham Ct.
$ 6075.00
Property Owner Name Address
City/State Zip •
Phone
Andrew Cifala 609 Stoneham Ct.
Fort Collins, CO 80525
493-3272
Applicant Name Address
City/State Zip
Phone
Andrew Cifala 609 Stoneham Ct.
Fort Collins, CO 80525
493-3272
Contractor Address
City/State Zip
Phone
DC Shortridge dba Gary Hal 1314 Webster Avenue
Fort Collins, CO 80524
493-3272
Contractor City of Ft Collins Sales Tax #
Are you paying taxes here or by report?
10 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? I7 Residential ❑ Commercial
If residential, is it: O Single Family Detached 0 Condo/townhome (single family attached) B Duplex
0 Multifamily (apartment) 9 Garage
If commercial, is it: 11 Bank 8 Bar ❑ Church 8 Hotel/Motel ❑ Medical office 12 Office ❑ Retail
❑ Restaurant 0 Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No If yas, you may need to contact HistoricPresemation
If this is for a demolition permit, what year was the building constructed?
Ifjonor to 1975, you will need an asbestos assessment to submit with this application.
Description of work Replace existing furnace with a 110k BTU. 80% furnace & replace A/C system with a 3-ton, 13SEER system
*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. MgftflY wgrc llY hem SMAid9,
Dennis ce s E- ;�a"ro°°°„
' . P.,w.I.yr.. W wa.a P°n, mina
Applicant Shortridge-a `..,. o.=„
PrintName:DenniS Shortrldge Signature — - Date 4/9/2019