HomeMy WebLinkAbout416 Lilac Ln - Applications/Furnace - 09/29/2017Fort of
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 ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
11 V buc7YO 09/29/2017
Application # Date
For ofFce use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
416 LILAC LANE
$11990.00
Property Owner Name
Address City/State Zip
Phone
MIKE DOERFLER
2926 BRUMBAUGH DR, FT COLLINS CO 80526
970-223-6126
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?
O Here ❑ Report
Sales tax number isrequlredbyall contractors .
Are you paying with your trust account?
9 Yes ❑ No
26862
Is this a residential or commercial project? O Residential ❑ Commercial
If residential, is it: E Single Family Detached ❑ Condo/townhome (single 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 more? ❑ Yes 0 No Ifyes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If pnor to 1975, you will need an asbestos assessment to submit with this application.
Description of work REPLACE FURNACE 80%
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City 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
ON mKARENA xNWK 111
Print Name: KARENA HUNTWORK signature HUNTwORK Date 09/29/2017