HomeMy WebLinkAbout3000 Ross Dr - Applications/Mechanical - 12/20/2013Dec 19 2013 07:11PM HP Fax
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Fort of
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 # ?:;o I301 # 6 U P) Date 2-VC • 2-0. 7-0 (S .
For office use only
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job Site Address (required)
Value of Construction (labor, materials, profit)
3000 Ross Drive #F-29
$6,500.00
Property Owner Name Address
Clty/State Zip
Phone
Scott Bluhrn 3000 Ross Dr.
#F-29 Fort Collins, CO 80526
970-222-3379
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 M Report
Safes tax number isrequired byall contractors,
Are you paying with your trust account?
IR 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 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 2.5 ton heat pump air handler and heat strips
*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: Stacey Schmidt
Print Name: Signature
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Date 12/19/2013