HomeMy WebLinkAbout555 E Saturn Dr - Applications/Furnace - 04/01/2013Mar 29 2013 10:20AM Altxachts One Hour 9706634097
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City Of Planning, Development & Transportation
For N. College Ave P.O. Box 580
Fnr"t 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
0 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 # b `
For oh9ce use only
Job Site Address (required)
555 Saturn Drive
Property Owner Name Address
Date LA
Value of Construction (labor, materials, profit)
$2000.00
City/State Zip Phone
-- •• vv t I /- t3'I
Applicant Name Address Clty/State Zip Phone
Albracht's One Hour Heating & Air 487 Denver Avenue Loveland, CO 80537 970-6634002
Contractor Address City/State Zip
Albracht's One Hour Heating & Air 487 Denver Avenue Loveland, CO 80537 phone
970-663-4002
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here Report
sales tax number isregwredbyallconrractom Are you paying with your trust account? ® Yes ❑ No
Is this a residential or commercial project? ® 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 Ifyes, you may need to contactH/stor/cArdYerva on
If this is for a demolition permit, what year was the building constructed?
Ifpr/or to 1975, you will need an asbestos assessment to submit with this app/tcatan,
Description of work Keplace furnace
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the compianynameorCity offtCo//insllcense'o
BectrkJan 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: Stacey Schmidt
Print Name: Signature Stacey Schmidt &,U29/2013