HomeMy WebLinkAbout919 Marble Dr - Applications/Furnace - 10/11/2016From 9702299983 1.970.229.9983 Tue Oct 11 16:08:16 2016 MDT Page 2 of 4
FROM : FAX NO. :
Oct. 11 2015 10:06PM P2i4
City of
Fort Cothns
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). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
El Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater 0 Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applicatione will not be accepted,
Application # . � �1 I
For office use only
Date 10/11/2016
Job Site Address (required) Value of Construction (labor, materials, proflt)
919 MARBLE DR $4980.00 y�
Property Owner Name Address City/state Zip Phone
BRUCE WAGNER 919 MARBLE DR, FORT COLLINS CO 80526 970-266_9976
Applicant Name Address City/State Zip Phone
Contractor Address City/state Zip Phone
NORTHERN COLORADO AIR INC. 812 STOCKTON AVE, FT COLLINS CO 80524 970-223-8873
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? El Here ❑ Report
Sales tax number is required by allcuntracturs . Are you paying with your trust account? ® Yes ❑ No
26862 _
Is this a residential or commercial project? 0 Residential ❑ Commercial ~
If residential, is it: 0 Single Family Detached ❑ Condo/townhome (sinclle family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or rnore? Q Yes ® No If yes, you may need to contact Historic Preservation
If this is fora demolltlon permit, what year was the building constructed? _
Ifpnor'to 1975, you will need an asbestos assessment to submit with [his application.
Description of work REPLACE FURNACE 95%
*If lawn sprinkler/backfiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: ,Gist the company name or crty of Ft Collins 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: KARENA neH,a��rx�r�u
Print Name!KARENA HUNTWORK S HVNTWORK R"A�N" '` Date 0111! ... Signature _..._.. u.;°h� �.;;n:,�wn.,���.r 1 .. 2016
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