HomeMy WebLinkAbout6320 TREESTEAD RD - APPLICATIONS - 6/14/2019Fort 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). 0 Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit O Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line Cl Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line Q Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable
Information on the application. (
Application # I I V, o
For office use only
Incomplete applications will not be accepted.
Date 6/14/2019
Job Site Address (required)
Value of Construction (labor, materials, profit)
6320 Treestead Rd.
$ 4600.00
Property Owner Name Address
City/State Zip
Phone
Suzanne Saunders, 6320 Treestead Rd.
Fort Collins, CO 80528
493-3272
Applicant Name Address
City/State Zip
Phone
Darrow Clark 1314 Webster Avenue
Fort Collins, CO 80524
493-3272
Contractor Address
City/State Zip
Phone
DC Shortridge dba Gary He 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
Sales tax numberisrcquiredbyaiicontactors _
Are you paying with your trust account?
M Yes ❑ No
34734
Is this a residential or commercial project? 0 Residential O Commercial
If residential, is it: 0 Single Family Detached 9 Condo/townhome (single family attached) 9 Duplex
13 Multifamily (apartment) 8 Garage
If commercial, is it: ® Bank 0 Bar 17 Church 0 Hotel/Motel 0 Medical office 9 Office 0 Retail
I] Restaurant 0 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 asbesW5 assessment to submit with this application.
Description of work Replacing AC with a 4-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 Co 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. oiaw nv ."eMe n, pen Sa Odge
Dennis k
F';°.ANmRnNs.I yeespecified pacts o/WeApplicant a Sh0ltfi�oDennis ShortridPrint Name: 9 Signature - t Date 6/14/2019