HomeMy WebLinkAbout324 N Shields St - Applications/Furnace - 03/27/2013Mar 25 2013 03:35PM Albrachts One Hour 9706634097
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Fort Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax224-6134
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 Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stave (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application #
B(30(330
For ofte use only
Date F
Job Site Address (required)
Value of Construction (labor, materials, profit)
324 N Shields
$4648.00
Property Owner Name
Address City/State Zip
Phone
Justin Brown
324 N Shields Fort Collins, CO 80521
970-222-8924
Applicant Name
Address City/State Zip
Phone
Albracht's One Hour Heating & Air
487 Denver Avenue Loveland, CO 80537
970-663-4002
Contractor
Address City/State Zip
Phone
Albracht's One Hour Heating & Air
487 Denver Avenue Loveland, CO 80537
970-663-4002
Contractor City of Ft Collins Sales Tax # Are you paying taxes here or by report?
❑ Here 29 Report
Sales tax number is required bya!l cvnbactors.
Are you paying with your trust account?
C1 Yes ❑ No
Is this a residential or commercial project? n Residential ❑ Commercial
If residential, is it: ® 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 ❑ No If yes, you mayneed to contact HlstoricPrese"Non
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
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time QC, must list licensed electrician.
Su bcontractors: List the company name or City offt Colfrns Acense 0
Electician Plumber Mechanical I 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: Stacey Sc&m& t 43/251203
Print Name: Signature gate