HomeMy WebLinkAbout6132 POLARIS DR - APPLICATIONS - 11/8/2017 (2)Planning, Development & Transportation
City of 281 N. College Ave P.O. Box 580
For1t 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). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
O 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.
Application # t5l-ID1(P09 Date
For office use only
11 /08/2017
Job Site Address (required)
Value of Construction (labor, materials, profit)
6132 POLARIS DR
$2,475.00
Property Owner Name
Address City/State Zip
Phone
JASON POWELL
6132 POLARIS DR, FT COLLINS CO 80525
Applicant Name
Address City/State Zip
Phone
POEHLMAN CONSTRUCTION
2600 CANTON CT, FORT COLLINS CO 80525
970-278-1930
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?
El Here ❑ Report
sales tax number isrequiredbyall contractors.
Are you paying with your trust account?
V Yes ❑ No
26862
Is this a residential or commercial project? O Residential ❑ Commercial
If residential, is it: 17 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 O No Ifyes, you mayneed to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If prior 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:
Print Name: KARENA HUNTWORK Signature
HUNTWORK
Date 11 /08/2017