HomeMy WebLinkAbout4436 Vista Dr - Applications/Furnace - 11/05/2012Nov 05 2012 12:03PM Gary Hooley Heat and Air 9702249198
page 2
Fort Cothns
Planning, Development & Transportation
281 N. College' Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
6,
This application is to be used to apply for the following permits only (check all that apply). 0 Air Conditioning
O Demolition (interior non-structural) 0 Electrical Alteration (not service change) ❑ Gas Lighter 0 Gas Log
O Heating Unit 0 Lawn Sprinkler ❑ Mobile Home replacement 0 Roofing 17 Sewer Line 0 Photo -voltaic
Cl Ventilation t7 Water Heater 0 Water Line O 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
Far office use only
Date 11/5/2012 11-15
Job Site Address (required)
Value of Construction (labor, materials, profit)
4436 Vista Drive
$2,963.00
Property Owner Name Address
City/State Zip
Phone
Mike Thompson 4436 Vista Drive
Fort Collins, CO 80526
568-6608
Applicant Name Address
City/State Zip
Phone
Mike Thompson 4436 Vista Drive
Fort Collins, CO 80526
568-6608
Contractor Address
City/State Zip
Phone
Gary Hooley Heating & Air 1314 Webster Avenue
Fort Collins, CO 80524
493-3272
Contractor City of Ft. Collins Sates Tax #
Are you paying taxes here or by report?
O Here O Report
Sales tax number isrewlndbyall ca%li-atmrs.
Are you paying with your trust account?
G Yes 13 No
34734
Is this a residential or commercial project? M Residential O Commercial
If residential, is it: 0 Single Family Detached 0 Condo/townhome (single family attached) 0 Duplex
0 Mui`.ifamily (apartment) 0 Garage
If commercial, is It 17 Bank 13 Bar CI Church 12 Hotel/Motel C Medical office 0 Office Q Retail
0 Restaurant 0 Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No If yes; yw may need to contact H1swt c Preservation
If this is for a demolition permit, what year was the building constructed?
tfprior ha I975, you wl// need au asbestos assessment to submit wfih this appl/cation.
Description of Work Regiace furnace
�� rnwrr spruuueriaaacnow preventer, must list licensed plumber. If first-time A(C, must list licensed electrician.
Subcontractors; t& bt a company name orCllYOPtCollinslicenSL- AF
Eectridan_Creekside Plumber Mechardorl H-1654
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 hereln 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; Shell Swanson
Print Name: y Signature
Date li' ��-