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Fort Collins Residential Energy code
MECHANICAL _DISCLOSURE FCIRM
Job Address.
General contmctnrr
Mechanical contra for
INSTRUCTIONS
This disclosure form Is to be signed by the mechanical contractor or representative of the general contractor.
Please type or print, except for the signatunt.
If there are multiple systems serving any function, make multiple entries to describe them.
One copy of this form must be provided to the Building and Zoning Department prior to the C.O.
One copy Of this form must be made sva.ilak,!e to the ^rtmina! hc.^ e buyer.
the building & zoning dept. of
Community Planning and Environmental Swrvin.w
1$7 N. College Ave., P.O, Box W, Fort COMM, Co 60522 .
vrir - G'm m. rs..�
' FAX a! V 224 01 J4
A. apace iteafung system
B. Space cooling system
C. Water heating system
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Me certify that the above -listed equipment (including ducts and piping) was installed In the building at the above locations
In conformance with the requirements of the Fort Collins Residential Energy Code and Mechanical Cade; and further, that
such equipment was Installed in accordance with manufacturers' Instructions.