HomeMy WebLinkAbout1809 GOLDEN WILLOW CT - APPLICATIONS - 11/22/2017 (5)Fort Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
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
* Heating Una ❑ 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 # e,i 01 01-13 Date
For ofc>° use only
11 /22/2017
Job Site Address (required)
Value of Construction (labor, materials, profit)
1809 GOLDEN WILLOW CT
$3390.00
Property Owner Name Address
City/State Zip
Phone
SCOTT MCINTOSH 1809 GOLDEN
WILLOW CT, FORT COLLINS CO 80528
970-204-1455
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?
O Here ❑ Report
Sales tax number is requiredbya//contractors
Are you paying with your trust account?
m Yes ❑ No
26862
Is this a residential or commercial project? O Residential ❑ Commercial
If residential, is it: O 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 may need to contact hhstonc Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you w111 need an asbestos assessment to submit with this application.
Description of work REPLACE FURNACE 95%
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Lrstthe company name orOtyofRCollins 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 °".
Print Name: KARENA HUNTWORK Signature HUNTWORK Date 11/22/2017