HomeMy WebLinkAbout620 Powderhorn Dr - Applications/Furnace - 12/07/2016From 9702299983 1.970.229.9983 Thu Dec 8 07:04:19 2016 MST Page 2 of 8
FROM 'FAX NO. Dec. 08 2015 02:00PM P2/8
City of Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins 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). 171 Air Conditioning
❑ Demolition (interior non-structural) fl Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
B Heating Unit ❑ Lawn Sprinkler iJ Mobile Home replacement ❑ Roofing D Sewer Line C] Photo -voltaic
❑ Ventilation D 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 # LL IF) - Date 12/07/2016
Fur v4�be use only
Job Site Address (required')
620 POWDERHORN DR
Property Owner Name
DOUG STOLL
Applicant Name
Value of Construction (labor, materials, protit)
$2, 940.00
Address City/State Zip
620 POWDERHORN DR, FTC 80526
Address City/State . ' Zip
Phone
970-491-3708
Phone
Contractor Address City/State Zip Phone
NORTHERN COLORADb AIR INC. 812 STOCKTON AVE, FT COLLINS CO 80524 970-223-8873
Contractor City of Ft. Collins Sales Tax #
Sales tax number /5Iequlrnd by aN rr,otr6,ctors.
26862
Are you paying taxes here or by report? O Here ❑ Report
Are you paying with your trust account? ® Yes ❑ No
Is this a residential or commercial project? EI Residential ❑ Commercial
If residential, is it: O Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage,
If commercial, is it: M Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical -office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ® No If yes, you may naed to contact Historic Hreserva
If this Is for a demolition permit, what year was the building constructed?
i1 prior to 1.97.5, you will nccd an asbestos assessment tU submit with this r4pplicc3t/cn.
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: List the .company name or City of Ft Collins license #
Electricia r __._ ,., 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 �; ;„� •^^
Print Name, RENA HUNTWORK ..." KA Signature _HIfNTVVORK Date 12/07/2016 __