HomeMy WebLinkAbout1703 Somerville Dr - Applications/Furnace - 06/25/2017Jun 25 2017 10'00AM Gary Heotey HVAC 9702241108
page 2
Fo'Nobollins
OVER-THE-COU
Planning, Deerelopment 8l Transportation
I261 N. College Ave P,O, 11= 560
Port Collins, CO $0524
Phone 9y0-41E2740 Fax 2248134
I
PERMITS ONLY
This application Is to be used to apply for the following perolts only (oheok an that apply). W Air Conditioning
G Demolition (Interior non-structural) 13 Electrical Alteration (notaervico change) O Gas Lighter G Gas Log
to Heating Unit C7 Lawn Sprinkler O Mobile Home replacement 0 Sooting O Sewer Line O Photo-voltalo
O Ventilation O Water Heater O Water Line Q WoodlPellet 8y vs (mull be EPA cerllffed, provide make, model and
manuracturso.
Complete all applicable Information con( the application. incojnplets epplWations will not be accepted.
Appllcatlon #r - Tv3u �Jw ;D &2&2017
Par ofte an&W
Job gibe Address (modmd)
Value of s#rucgon (labor, materials, profit)
1703 Somerville Drive
$4,250.00 0 a 5
Property Owner Name Address
iiy/baba Zip -
Phone
Brian Banister 1703 Somerville Drive
F�j Colins, CO 80620
481-5786
Applicant Name Address
4ty/Stata Zip
Phone
Orlan Banlater 1703 Somerville Drive
F rt Collins, CO 80526
481-5786
Contractor Address
dwstat: Zip
Phone
DC Shortrldge dba Gary HM 1314 Webster Avenue
F Collins, CC 80624
483-3272
Contractor City of FL Collins Sales Tax #
Are you �aying taxes here or by report?
m Here 0 Report
SMV
Are you paying with your trust aceourrt>
M Yes G No
4rar
3473
Is this a residential or commercial project? m Residential O merdal
If residential, Is IV m Single Family Detached 0 Condlwtown a (single family attached) 0 Duplex
0 Multlfamly (apartment) G Garage
If commercial, Is It: Q Bank 0 Bar O Church G Hotal/Motal ;3 Medical omcs G office 0 Retail
t7 Restaurant 0 Other (explain) a
Is this bulldhrg il0 years of age or more? G Yes ONO ff ANYtaed to con&&HLso7rtc AvswrmWn
if this is fora damollMen psmdt, what year was the building; m uebw
rpt:for to 1975, PW WAY need an Agesm awassn ant to brlA#W tits 4Wftd�l
Description of vvork� �
*If lawn sprinkler/backflow preventer, must list Bearded plumber. 719*=
AIC, must list licensed electrician.
Subconitractorar Lst the cavnp&V n&m or a& ofR CW#ns #sense I
�
Electrician Creekeide Eleetft Plumber Med=d0l H-teiL4
Rooter Other
I hereby acknowledge that 1 have read this application and state that th above information Is complete and coned. I agree to
comply with all requirements cotnasted herein and city Ordfnences and to taws regulating bulk9ng construction, Y know that a
permit Is not vaNd until It Asa been paid and Issued.
APPII Shell Swanson
Pdnt Name: y sfigneturo�11AA1 oats r%