HomeMy WebLinkAbout1425 Salem St - Applications/Furnace - 12/12/2013Dec 12 2013 08:55AM HP Fax
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City +of
F6r` Co lies
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 # RI yu4iA-1 Date DFc12. ui 2)
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
1425 Salem Street
$4465.00
Property Owner Name Address
City/State Zip
Phone
Elizabeth Pederoza 1425 Salem Street
Fart Collins, CO 80525
970-412-8364
Applicant Name Address
City/state Zip
Phone
Albracht's One Hour Heating & Air 487 Denver Avenue Loveland, CO 80537
970-663-4002
Contractor Address
City/State Zip
Phone
Albracht's One Hour Heating & Air 487 Denver Avenue
Loveland, CO 80537
970-663-4002
Contractor City of Ft Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here M Report
Sales tax number is required by all contractors
Are you paying with your trust account?
CR Yes ❑ No
Is this a residential or commercial project? El Residential ❑ Commercial
If residential, is it: ® Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No If yes, you may need to contactHistoric Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work F.eplace-90K$TU furnace
*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 #
Eleadcan Plumber Mechanical Roofer
Other
I hereby acknowledge that I have read this application and state that the above information lsxrmpl-t- end -nr—ft T anrav rn .
comply with all requirements contained herein and city ordinances and state laws regulating building construction. I know that a
peen it is not valid until it has been paid and issued.
Applicant' Stacey Schmidt
Print Name: Signature
s se""*
IFS
12/11/2013