HomeMy WebLinkAbout2018 Coastal Ct - Applications/Furnace - 02/21/2020Planning, Development &Transportation
City. of 281 N. College Ave P.O. Box 580
Fol ` CollinsiFort 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 ❑ Electrical Alteration ❑ Gas Lighter ❑ Gas Log ff] Heating Unit ❑ Lawn Sprinkler
❑ Mobile Home replacement ❑ Sewer Line ❑ 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.
Application # E-Sg6)15I;t- Date 02/19/2020
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
2018 COASTAL CT
$3,655.00
Property Owner Name Address
City/State Zip
Phone
SCOTT & SUSAN SIMPSON 2018 COASTAL CT, FTC CO,80528
970-206-1111
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?
N Here ❑ Report
Sales tax number is required by all contractors.
Are you paying with your trust account?
IR Yes ❑ No
26862
Is this a residential or commercial project? 17 Residential ❑ Commercial
If residential, is it: 111 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 mayneed to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description Of work REPLACE FURNACE
*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 HUNTWORK
Print Name: Signature
KARENA HUNNVORK} HUNTVVORea by Knaerin
Date: 2020.01.3014:56:294TOu Date 02/19/2020