HomeMy WebLinkAbout1020 Rolland Moore Dr - Applications/Furnace - 12/09/2016From 9702299983 1.970.229.9983 Fri Dec 9 08:18:18 2016 MST Page 2 of 7
FROM FAX NO. Dec. 09 2015 03:14PM P2i7
City of Planning, Development & Transportation
281 N. College Ave P.O. Box 580
,Fort 1t , Collins Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER-THt-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 EJ Gas Log
O Heating Unit L7 Lawn Sprinkler L7 Mbbile Home replacement C7 Roofing Ll Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line 0 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 #.._ I�1JO��V Date 12/09/2016
For olri(e tlSe only
lob Site Address (required) Value of Construction (labor, materials, profit)
1020 ROLLAND MOORE #4E $1,790.00
Property Owner Name Address City/State Zip Phone
ROB GRAY 1433 MEEKER DR, FTC CO 80524 970-482-2842
Applicant Name Address City/State Zip Phone
Contractor Address City/State Zip Phone
NORTHERN COLORADO AIR INC. 8.12 STOCKTON AVE, FT COLLINS CO 80524 970-223-8873
Contractor City of FL Collins Sales Tax # Are you paying taxes here or by report? S Here ❑ Report
sales tax nu,M,er is revuired by an cunfrrr.tora, Are you paying with your trust account? @ Yes ❑ No
26862
Is this a residential or commercial project? O Residential ❑ Commercial
If residential, is it: ❑ Single Family Detarhed 0 Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartrYient) ❑ Garage
If commr:.rcial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel 0 Medical office ❑ Office ❑ Retail
.❑ Restaurant O Other (explain)
Is this building 50 years of age or more? ❑ Yes fit No If yes, you may nrWd to contact Histanc Pteservatmn
If this is for a demolition permit, what ydar was the building constructed?
/(prior to 1975 YOU Ivlll need an dcbestos i3sses5ment to submit with this application.
Description of work REPLACE FURNACE 80%
*It lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Llst the company name or 0ty of Ft Collins license A
LIKInnan 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 slate laws regulating building construction. I know that a
permit is not valid until it has been paid and Issued.
Applicant: KARFNA •,��•-•�•-��
Print Name: KARENAHUNTWORK., Signature
._ .•..-•.-... ..Date 12/09/2016