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02/04/1999 14:05 9702299983 NCA
residential energy
PAGE 02
Job address:
^General contractor:
Mechanical contractor.
Space heatirig.sys .orn
Space cooling system
Water heatlrtg system
Certification
ONO certHy that the above -listed equipmsnt was installed in the budding at the above locations in conformance with the
current requirements of the City of Fort Collins Reaidentai Energy Code and Mechanical Code, and that it was installed in
accordance with manufacturses instructions, tNye certify that any ductwork has been metaled in conformance with
the current requirements of the Clty of Fort Colin% Residential Energy Code and Mechanical Code.
Certified by: F0BM R MILLER Phone: (970) 223-8873
Business firrtn COLORAW AIR, nX.Dats:
Address:1823 E HAP147NY RD Signature:
Instructions
This disclosure form is to be signed by the mechanics! contractor or representative of the general contractor.
Plans* type or print, except for the signature.
If there are multiple systems serving any function, make multiple entries to describe them,
One coot' of this form shall be provided to the Sudding and Zoning Department atonal inspection,
One copy of this form shall be provided to the homebuyer.