HomeMy WebLinkAbout1533 Purple Sage Ct - Applications/Mechanical - 07/02/2013Jul 02 2013 10:58AM Albrachts One Hour 9706634097
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City of
Foort 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 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 # N1 �Jwdop� • Date l
for office use only
lob Site Address (required)
Value of Construction (labor, materials, profit)
1533 Purple Sage Court
$10,783.00
Property Owner Name
Address City/State Zip
Phone
David VanDerMerwe 1533 Purple Sage Court Fort Collins, CO 80526
970-690-5713
Applicant Name
Address City/State Zip
Phone
Albracht's One Hour Heating & Air
487 Denver Avenue Loveland, CO 80537
970-663-1002
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 IN Report
sarPstax number isrequIredbyall con&actos.
Are you paying with your trust account?
LA Yes ❑ No
Is this a residential or commercial project? &I Residential ❑ Commercial
If residential, is it: 10 Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office [I Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes E] No If yes, you may need to contact Historic Pre--zowtion
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 and AC
*If lawn sprinkler/badcflow preventer, must list licensed plumber. If first-time A/c, must list licensed electrician.
Subcontractors. List the company name or City of FtCollins %cense#
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. C'
Applicant' Stacey ✓ 07/02/2013
y Schmidt
Print Name: Signature Date