HomeMy WebLinkAbout850 Napa Valley Dr - Applications/Furnace - 02/18/2016From 9702299983 1.970.229.9983 Thu Feb 18 14:28:19 2016 MST Page 2 of 5
FROM FAX NO. Feb. 18 2017 09:26PM P2/5
C(y 0f planning, Development & Transportation
2131 N. College Ave P.O. Box 580
Flirt Collins Fort Collins, CO 80524
`Ie� 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 ail that apply). El Air Conditioning
❑ emolition (interior non-structural) ❑ Electrical Alteration (not service change) L7 Gas Lighter El 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).
Complate all applicable information on the application. Incomplete applications will not be accepted.
Application # 1. C'r-fibi Date
For offlce use only ��~
Is this a residential or c mmercial project? R'Residential ❑ Commercial
If residential, is it: Single Family Detached ❑ Condo/townhome (single family attached) •❑ Duplex
Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel CI Medical office ❑ Office Q Retail
❑ Restaurant ❑ Other (explain) _,, ,,,,,,•,•_•,.
Is this building 50 years of age or more? ❑ yes ONO Ir'yes, you mayneed td Contact Historic Preser►�ation
If this is for a demolition permit, what year was t e building constructed? -_
Ypnor to 1975, you will need an asbestos assessment to subm/t with tlr/s application.
Description of work
..V, vURNACE — 5 n
*If lawn sprinkler/backfiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician,
Subcontractors; Gist the company name or City of Ft Coll/ns license *
Electrician Plumber Mechanical 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.
Applicant: �, ,� .
Print Name. a lnla �' T/ Sig - _--. - Date c� A,ce _