HomeMy WebLinkAbout805 ROCKY RD - APPLICATIONS - 7/8/2019City of
F6rt 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). O 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 # b/ (0o q 9Date
For office use only
7/8/2019
Job Site Address (required)
Value of Construction (labor, materials, profit)
805 Rocky Rd.
$ 3002.00
Property Owner Name Address
City/State Zip
Phone
Keith Vogt 805 Rocky Rd.
Fort Collins, CO 80521
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 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?
10 Here ❑ Report
Sales tax number is required by all contradors.
Are you paying with your trust account?
M Yes ❑ No
34734
Is this a residential or commercial project? M Residential G Commercial
If residential, is it O Single Family Detached 9 Condo/townhome (single family attached) 9 Duplex
❑ Multifamily (apartment) 9 Garage
If commercial, is it: ❑ Bank 9 Bar ❑ Church 9 Hotel/Motel ❑ Medical office 9 Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No If yes, you may need to contact HistoricPreservetion
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 Install new 2-ton. 13seer AC system
*If fawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Llst the company name or City of Ft Collins license #
HectricianA&M Electric 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. j �pl npy ogaee by SenEhaMege
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Applicant: Shortridge laa4an
Print Name: Dennis Shortridge Signature Date 7/812019